According to the news of the National Health Insurance Administration on December 19, in the process of promoting the reform of medical insurance payment methods such as payment according to disease diagnosis-related groups (DRG), many places have explored and supported the development of new medical technologies and the treatment of difficult and severe diseases.
DRG payment is based on the diagnosis of the disease, the way of ** and the individual characteristics of the patient, etc., to form different diagnosis-related groups, each diagnosis-related group to determine a unified payment standard. Compared with the traditional payment method, DRG payment is a more scientific and refined medical insurance payment model, which uses the method of big data to group and package payment for disease diagnosis and treatment, so as to avoid problems such as "large prescription" and excessive diagnosis and treatment.
On November 1, at the Medical Insurance Government Service Sub-center of Xiema Street, Beibei District, Chongqing, the staff was explaining the medical insurance policy to residents. Xinhua News Agency (photo by Qin Tingfu).
According to the previously issued "Technical Specifications for National Medical Security DRG Grouping and Payment" and other relevant documents, for new technology projects that have been filed with the medical insurance agency, the payment standard for the disease group can be revised after 1 year of payment according to the projectFor special circumstances such as the length of hospitalization or the excessive hospitalization expenses, as well as other circumstances that can be applied for project-based payment with the approval of the medical insurance agency, a special application for project-based payment settlement can be made. In terms of the treatment of difficult and severe cases, it is clear that the weight value of the difficult and severe DRG group can be increased and the weight value of the mild DRG group can be reduced.
Some local medical insurance departments have explored the establishment of relevant mechanisms for DRG payment to support new medical technologies in the pilot work. For example, Handan, Hebei Province has clarified that the sick groups with abnormally high and abnormally low payment values can be paid according to the project, and the list of special **, special drugs, and high-value consumables can be included in the DRG group to ensure full coverageZhejiang, Henan, Guangxi, Guizhou, etc. have increased the weight of key discipline disease groups, appropriately reduced the weight of basic disease groups or common disease groups, and guided ** medical institutions to focus on the treatment of difficult and miscellaneous diseases, and improved the efficiency of medical resource allocation.
At present, most provinces have generally established a mechanism for the handling of special cases by individual discussion, and expert review is conducted for special cases with particularly complex conditions, particularly high costs, or objections to the grouping results, and those who meet the conditions can be paid according to the facts. (Reporter Peng Yunjia).