Central Plains Net News (Wang Hong, reporter from Zhengbao All Media) Starting this year, the payment method of medical insurance will usher in a comprehensive change. The reporter learned from the Henan Provincial Medical Security Bureau yesterday that in accordance with the national deployment, our province has issued the “Three-Year Action Plan Implementation Plan for the Reform of DRG/DIP Payment Methods”. The service medical institutions basically achieve full coverage of disease types and medical insurance funds.
What is DRG/DIP payment?
According to reports, DRG payment means payment by group related to disease diagnosis. That is, according to factors such as disease diagnosis, disease severity, and treatment methods, patients are divided into diagnosis-related groups with similar clinical symptoms and resource consumption. On this basis, medical insurance pays according to the corresponding payment standard. DIP payment, that is, payment based on the value of the disease, is based on the total budget mechanism, and the point value is calculated based on the total annual medical insurance payment, the proportion of medical insurance payment and the total score of each medical institution’s cases to form a payment standard. Standardized payment for cases.
New payment method
It will reduce hospital overtreatment of patients
At first glance, the reform of medical insurance payment method is mainly a reform between medical insurance and designated medical institutions , does not seem to be directly related to the medical insurance insured personnel. But in fact, deepening the reform of medical insurance payment methods will effectively improve the efficiency of medical resource use, improve the accessibility of medical services, and increase the enthusiasm of medical personnel, thereby effectively safeguarding the rights and interests of insured persons.
Compared with traditional pay-by-item, DRG/DIP payment is a more scientific and refined medical insurance payment model, which can help hospitals manage costs while taking into account clinical development. Before the DRG/DIP reform, medical insurance payment was paid on a project-by-project basis, that is, the actual medical expenses were calculated according to the project according to the number of projects checked and the number of drugs prescribed. The more patient care programs, the more revenue the hospital earns. As a result, paying by item encourages hospitals to provide patients with unnecessary medicines and tests, resulting in overmedical conditions. Implementing DRG/DIP payment to avoid excessive medical treatment can naturally reduce the burden of patients seeking medical treatment and save more “life-saving money” for the common people. The reform will also force hospitals to actively improve management and operation efficiency, improve the level of diagnosis and treatment and service quality, and help patients enjoy better diagnosis and treatment services and medical experience.