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| The reform of the payment method of medical services in China has entered the DRG era |
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| Author：中國銘鉉 企劃部 Release Time：2017-9-22 10:07:27 Number Browse：1670 |
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Medical network on September 22 - "this year is the national start DRG accept payment reform pilot project, the first year of today's national health development research center of family health (hereinafter referred to as the" health development research center ") of the general assembly, provide a mutual exchange, share experience platform, promote and reach a consensus. Hopes the meeting, let us further enhance the sense of urgency and the sense of responsibility and cohesion force, condensed wisdom, overcome difficult, try to accept payment on the pilot reform progress, gradually form can be copied, can promote the fee reform path and the mode." On September 14, the national health and family planning commission deputy director of the ma xiaowei said in "China DRG paying conference", DRG accept payment method "is a good pay system", is both a solution to cancel with medicine cure, measures to push forward the reform of setting up a comprehensive new compensation mechanism, and is also an effective method to improve the medical insurance fund utilization rate, can let the patient enjoy the fruits of reform, more reasonable allocation of medical resources, improve the quality of medical services, control the unreasonable growth of medical expense.
As fan zhimin, deputy director of the finance department of the national health and family planning commission, puts it, the way to collect fees is an important sign that the reform will be successful and effective. According to organizers, from policy makers, managers, in the field of domestic and foreign relevant clinical medical staff, researchers, enterprise or business the unit staff more than 2200 people attended the meeting, far above the organizers expected number. Therefore, it is not difficult to see that it is the consensus of medical workers to promote the payment reform of DRG, to play the role of control cost, cost reduction, quality and benefit.
What is the "national disease diagnosis related group" payment
DRG (Diagnosis Related Groups) to pay, also called press disease Diagnosis Related Groups receive pay, is the patient according to the complexity of the disease severity, treatment methods and the consumption of resources in several different Groups, as a group as the unit price respectively pack to payment of a payment method, is currently the most widely used international payment of hospital medical services, is the world recognized as the most effective one way of controlling medical expense.
According to the honorary director of the health development research center, the national press disease diagnosis related groups receive payment rules team leader professor zhen-zhong zhang introduces, DRG paying specification is in partial provinces and cities in draw lessons from international experience and China's implementation of DRG, on the basis of experiences and lessons, combining the concrete national conditions of our country and medical security system, and the actual situation of public hospital compensation mechanism created a set of application for the national system of public welfare charge pay.
Zhang explained in detail from the technical and the rules what is "national disease diagnosis related grouping" to collect fees. "There are three key words in this, 'diagnosis by disease' and 'grouping'. 'disease diagnosis' is what doctors diagnose when we get sick, which is related to the severity of the disease; 'correlation' is closely related to the methods used to treat the disease; 'grouping' is associated with resource consumption in the treatment of the disease. With these three main factors, all diseases can be grouped together. Team organization expert team to tens of thousands of article can be used as a diagnosis of the disease according to clinical similarity principle in 23 system first, and then classified into three major categories in the treatment way, set up the term clinical disease diagnosis standard set, this is the first time the disease diagnosis unify for the name of the C - DRG grouping ".
"DRG itself is a tool, like a lever, and the payment and charge is a pivot point, and this leverage leverages the pivot to bring about changes in the operating mechanism within the hospital. Because cost is the most important issue in hospital operation, the hospital can reduce unnecessary drugs and consumables, and reduce patients' medical expenses. In the future, the purchase and marketing mechanism of drugs and consumables will also change accordingly. Zhang zhenzhong said.
DRG payment reform is a system engineering that affects the whole health industry
On the city in our country public hospital comprehensive reform pilot guidance "the health of China's 2030 planning" the "much starker choices-and graver consequences-in" deepening the reform of medical health system planning, and in 2017, the latest of the general office of the state council on further deepening the reform of the basic medical insurance payment instruction opinion ", etc are put forward in the file to explore, pilot DRG payment reform.
In June this year, the national health development planning commission was held in shenzhen DRG paying a kick-off meeting for pilot reforms, determine in shenzhen three hospital of fujian province, sanming, karamay, and a total of 36 medical institutions to carry out the DRG pilot work.
Deputy director of the national health and family planning commission, ma xiaowei said in a speech, domestic and international experience has shown that collect pay reform is connecting patients, medical institutions and important policy of the government compensation hub, to regulate the behavior of medical service, promote the reform of medical drug area has played a major role. "Practice shows that payment by DRG is a tool of modern health economic management and an effective way of direct management of in-patient patients. DRG accept payment reform is a system engineering, the industry as a whole health of health information infrastructure, the unity of the health standard specification, the diagnosis and treatment of medical institutions, promoting cost as the core value of the dynamic adjustment mechanism, will play a positive role." "Said ma.
, said the Treasury Department deputy inspector of the social insurance ZuGuoYing practical experience at home and abroad show that the DRG pay health care costs in controlling the unreasonable growth, promote the medical institutions to reduce cost, improve the quality of medical services has played a positive role.
The reform of payment method is the most important and effective way to deepen the reform of medical reform and promote the joint reform of the three hospitals
According to the national health department deputy director of the planning commission system reform ZhuangNing introduction, last year the central committee of the communist party of China promulgated by the state council of the "healthy China 2030" planning outline explicitly put forward to build integrated service system. Zhuang ning believes that the reform of payment method, especially the reform of DRG, is very important for the completion of a hospital - centered service model.
"In terms of service supply, the number of medical services over the years has been blowout, but the growth of medical services has been far from keeping pace with demand," he said. At this stage, we should make good use of the service system of internal resource better, improve performance and ensure maximum service supply, can in the case of relatively insufficient resources, solve the problem of excessive growth services."
Last year's national health and health conference highlighted the need to improve the health care payment mechanism and reform of payment methods. This year, paid-for reform has been included in the focus of health reform, and has proposed a pilot program to reform DRG payment reform in conditional areas. Recently, the general office of the state council issued a guideline on further deepening the reform of the basic medical insurance payment method, which indicates that the reform has a more clear mandate and direction. Fan zhimin, deputy director of the finance department of the national health and family planning commission, said that the reform of the payment method is the most important and effective way to deepen reform and promote the reform of the three-way medical system. Reforming the payment method to standardize the behavior of medical service will play an important role in the reform of the medical and pharmaceutical field.
"From the international perspective, our country's medical charge way far behind the international process, the optimization of the key and difficult point for pay charge for medical service system, we still lack of substantive breakthrough, the current charge payment method can not effectively control the trend of medical institutions, medical service expense unreasonable growth remain, the medical treatment charge pays higher percentage of issues did not ease." "Fan said.
In fact, the payment method, especially the payment method of DRG, as the world macro, medium and micro economic leverage, can play a powerful function. "We should fully recognize the status and role of paid-for reform in deepening reform, and mobilize multiple parties to achieve the goal of comprehensive health care reform." Fan zhi min said, "to explore inpatient and outpatient special groups according to the part DRG paying, gradually establish a government-led, stakeholder consultation pricing mechanism, formed in accordance with the actual local charge payment reform path and mode, is the direction we deepen the reform."
In October 2010, the national health department of the planning committee, in conjunction with the health development research center, start the development of C - DRG work, formed by the national 37 735 clinical experts and more than 735 professional health economics, medical insurance and health management major research team composed of experts. Since 2006, preparations have been made for the completion of the C-DRG payment specification for 10 years.
"C - DRG payment method reform, is a kind of institutional reform, and represented by according to the project to receive payment after paying project in principle is different, its essence is a patient classification system, mainly based on clinical similarity, the similarity of resource consumption to patients divided into a number of DRG groups, and according to the classification standard of group, will be transformed into a variety of medical services output relative measurable service efficiency of the model. Compared to the current dominance of project pay is the qualitative change. "The pay-as-you-go reform that we have introduced is definitely a local reform plan," fan said. The goal is to control unreasonable medical expenses and optimize the price structure of medical services. Second, can drive cost accounting development, improve hospital refined management; Third, we can make use of DRG payment system advantage to achieve other goals of health reform, such as by adjusting the behavior of supply side, guiding the demand flow of medical treatment, and providing convenience for the rational medical treatment of the masses; Fourth, we can properly deal with unintended consequences and strengthen policy regulation and supervision. (Jiang Lei)
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