Medical network - July 4, issued by the general office of the state council on further deepening the reform of the basic medical insurance payment instruction opinion ", to comprehensively promote the reform of medical insurance payment next to deployment. What changes will be made to medicare payment reform? How to support the priority of medical reform such as hierarchical diagnosis and treatment? What is the impact on the balance of payments? Chen jinfu, director of the department of human resources and social security, has been reading about the issues of social concern recently.
We will implement the multiplex mode of payment
In view of the characteristics of different medical services, it is a highlight of the reform of the insurance payment method. This year, we will further strengthen the budget management of the health insurance fund, and fully implement the multiplex medical insurance payment based on the payment of diseases. By 2020, the reform of the insurance payment system will cover all medical institutions and medical services, which will be significantly reduced by the cost of the project.
"For example, to the hospital medical service, mainly according to disease, according to disease diagnosis related group (DRGs) pay, long-term, chronic diseases in the hospital medical service can pay by bed day; for primary care services, can be paid on a per head, actively explore the capitation payment and chronic disease management; the combination of complex cases to the unfavorable pay package and outpatient costs, can be paid according to the project. At the same time, explore the mode of payment in accord with the characteristics of Chinese medicine services." "Said Chen jinfu.
Opinions are proposed to focus on the payment of the disease, and improve the way of paying according to the head and the bed.
"In principle, the diagnosis and treatment and treatment scheme and ChuRuYuan standard more clearly, more mature disease by macro-reforms, ambulatory surgery and will be in conformity with the conditions of Chinese and western medicine outpatient service treatment into the macro-reforms. Promote outpatient service as a whole the capitation payment, from the standard treatment, the evaluation index of chronic diseases of clear. For psychosis, hospice care, medical rehabilitation need long-term hospitalization and average daily cost relatively stable disease, can be paid by bed day." "Said Chen jinfu.
Lead the staff to the primary level
Chen Jinfu said, along with reform unceasingly to comprehensively, establishing hierarchical diagnosis system, promote the reform of public hospitals, signing the family doctor service, for controlling the excessively rapid growth of medical expenses, and other key reforms task also payment for health care reform puts forward new requirements. To this end, opinions on the reform of health insurance payment methods to support graded diagnosis and treatment, family doctor, medical association construction, etc., have put forward specific measures.
"For example, to carry out the outpatient service as a whole the capitation payment, mainly relying on basic medical and health institutions, the conditional area can explore residents will sign the outpatient service fund capitation payment to basic medical and health institutions or family doctor team, referral of patients to hospital, by the grassroots health institutions or family doctor team pay a certain amount of referral fee; set total control targets, to the appropriate tilt of grassroots medical institutions, children's medical institutions, promote the development of grassroots medical institutions and medical institutions children." "Said Chen jinfu.
According to introducing, views on combination of hierarchical diagnosis and signing the family doctor service system construction, guide the ginseng protect personnel prior to the first option at the grass-roots level, to conform to the provisions of the referral hospitalized patients can continuous computing starting line. In addition, the opinion will also comply with the provision of the family doctor's contract service fee to cover the coverage of health insurance, to give full play to the role of the family doctor in the "gatekeeper" of the health care costs.
To increase the use efficiency of medicare funds
According to the statistical bulletin issued by the ministry of human resources, the total income of China's urban basic medical insurance fund totaled 130.84 billion yuan in 2016, with an expenditure of 1076.7 billion yuan. In the context of the rapid growth of medical expenses, health insurance funds have faced heavy payment pressure in recent years.
In response, Chen said that the principle of deepening reform of health care payment is clearly defined, and the first one is basic insurance, which is determined by the basic medical insurance system. We will continue to improve the efficiency of the fund's use and ensure its basic medical needs.
To pay limits, opinion strictly regulate the basic medical insurance liability boundary: focus on security in accordance with the "clinic needed, safe and effective, price reasonable" principle of drugs and medical services and basic services. Public health expenses, physical fitness or health care consumption that are not directly related to the treatment of diseases shall not be included in the coverage of medical insurance.
According to the requirements, local authorities should combine local realities and come up with concrete reform plans by September 30 this year, Chen said. For a wide variety of payment in the most demanding, technology the most complex according to the disease diagnosis related groups, the ministry of human resources and social security, national health and family planning commission will jointly with the ministry of finance, the state bureau of traditional Chinese medicine was established according to the disease diagnosis related group paid pilot working group, selection of parts according to the disease diagnosis related group paid pilot, strengthen technical guidance, and strengthen medicare payment reform achievements communication between different regions. |
