Attention! Hospitals under DRG blindly pursue balances, which may be suspected of fraud and insurance fraud! | Interview with Liao Zangyi

From the perspective of the original intention of the reform, the state intends to reform the DRG/DIP payment method to curb the Excessive payment of medical care has forced medical institutions to improve quality, standardize, control costs, and increase efficiency, reflect the value of medical personnel’s labor services through cost structure adjustment, and reduce the phenomenon of “one after another” fraud and insurance fraud.

However, after the implementation of DRG/DIP, the reform did not meet policy expectations in terms of reducing fraud and defrauding medical insurance funds. .

“DRG has not changed the profit-seeking tendency of medical institutions, due to the professionalism and information asymmetry of medical care. Even if DRG is implemented, the situation of fraud and insurance fraud is still severe.” Liao Zangyi pointed out to the health community. (For details, please refer to “After DRG/DIP payment is made, why are fraudulent insurance cases not decreasing but increasing?)

In addition, the DRG/DIP pricing tool itself has many technical defects, and some policy settings in the practice area are not reasonable enough,

span>All of this leaves a moral hazard potential for medical institutions.

So, what are the technical defects of DRG/DIP? What are the unreasonable aspects of the relevant policy settings? What kind of alienated medical service behavior of fraud and insurance fraud will be induced?