In the early years, patients were most anxious about which hospital to go to and which doctor to find.
In the past two years, the patient's anxiety has increased again, that is, the disease he has can score in the hospital.
Yes, you heard it right, the hospital now will give a score to the patient.
Often, the more severe the illness and the more advanced the surgery and technology required, the higher the patient's score, and at this time, the hospital can get more money from the health insurance bureau.
Correspondingly, if the patient scores low, the hospital will get less money.
Speaking of which, some people will think that the so-called low-scoring patients should have very mild symptoms and nothing wrong.
In fact, common chronic patients and patients with incurable diseases are also low-scoring patients in hospitals.
Therefore, many people will encounter a limit when they are hospitalized**, and some patients will be persuaded by the hospital to be discharged.
At this point, the second question is involved:
How did this score come about?
This score comes from the medical insurance DRG payment system.
Since 2019, the National Health Insurance Administration (NHSA) has implemented the management of patients by disease group, abbreviated as DRG.
The DIP of the disease is refined on the basis of DRG.
Each patient is divided into different disease groups, and each group corresponds to a corresponding score, which corresponds to a fixed medical insurance settlement amount.
Which group the patient is assigned to means how much money the hospital can get from the health insurance bureau in the end.
For the hospital, this money is not refunded, and it is profitable.
If it is less, if the department has to fill it by itself, it will be a loss.
At this time, there is a question, how did this corresponding medical insurance settlement amount come out?
In our domestic DRG payment system, it is the average cost of the disease that is determined by the hospital in the past three years.
Combined with the region, because the current medical insurance is coordinated at the municipal or provincial level, the total average cost of the disease in hospitals within this range is obtained after the combination of the two.
This amount will be dynamically adjusted every year.
From this point of view, the paid design of this DRG is still very scientific and practical.
Because the city's medical insurance pool is so large, hospitals are robbing money by their ability.
If this hospital overspends too much on DRG, it is equivalent to working for other hospitals.
If the hospital keeps the cost of this group too low, the allocation for this group will be less in the second year according to the principle of calculating the three-year average cost.
Therefore, under the design of this rule, the ideal state of the hospital is that the hospitalization cost of each patient can be controlled between 95% and 100% of the quota of the disease group.
The above basically explains how and why the patient is hospitalized, how to be scored, and why to score.
Next, I will follow the conversation and talk to you about a few more hospitals.
The first one, the medical insurance DRG payment system, which has been controversial by patients and complained by doctors, is highly supported by me.
DRG originated in the United States in the 60s and then spread all over the world.
DRG is not only used to control medical insurance costs, but also to reduce the waste of medical resources.
Our actual problem now is that medical insurance is very tight, and patients themselves have no money, so it is normal for hospitals to be a little more tired than before.
However, this should not negate the reform of the medical insurance system.
In other words, we don't use the world's proven scientific payment system, so doctors, do you have a better way?
Second, at a time when the tension of medical insurance is visible to the naked eye, I hope that the relevant departments can rebalance, and in the distribution of medical insurance, whether to be inclusive or continue to be graded.
This topic will not go into depth, everyone understands what is going on.
Third, under the situation of DRG cost control, whether the hospital should protect the department or balance the whole.
If the department, such as neurology, cardiology, orthopedics, etc., has high-value consumables or large amounts of drugs, they will earn more.
Like pediatrics, emergency departments, etc., they earn very little.
Over time, this will create departments that do not make money, and will desperately compress patients.
Departments that make money will go hard and increase the average cost of the sick group.
The final result is that the patients are not satisfied, the medical insurance is not saved, and the doctors have great opinions, forming a three-lose situation.
To ensure the whole, it is to take the hospital as a unit, rather than the department as a unit, to comprehensively balance the profits and losses of patients.
At least there is more and more news that patients will not be discharged from the hospital in a cycle of 15 days.
Fourth, the promotion of the DRG system will make medical resources more concentrated, and patients will be concentrated in the top three in the municipal and provincial capitals.
The ** hospital in the county has no patients, guarding a huge amount of examination equipment, and the continuous loss declines, forming a vicious circle.
Not only has the grading system become empty talk, but the survival of grassroots hospitals is a big problem.
This is a major adjustment of the policy, and there is no way, the patients will vote with their feet.
Fifth, on the question of the work of doctors.
One of the problems reflected in the strike of South Korean doctors is that the treatment of doctors is not low, and some hospitals are even comparable to those in Europe and the United States.
It's the distribution mechanism within the hospital, and something goes wrong.
This distribution gap is not only between different hospitals, but also within the same hospital, and the salaries that small doctors and big doctors, internists and surgeons in the same department can get paid.
Interestingly, medical staff in this industry fantasize that one day they will be able to survive to the top of the distribution chain, so they dare not say, do not want to say, and are unwilling to say about the current internal distribution mechanism.
I am reluctant to break the rules so that one day, I can enjoy the benefits brought by this rules.
What leads to the final transmission to society is that medical staff do too much work and are too poorly treated.
For this reason, many news examples are intern doctors, as well as **people.
Let me ask, can you make the income of the head of the department public?
In fact, this is not a secret, on some explosive news, the income of the director or dean is beyond many people's imagination.
This is not over, and now it has begun to render, since the promotion of this DRG payment system of medical insurance, patients and doctors have been miserable.
The question is, is that the crux of the matter?
Finally, by the way, the South Korean people call the doctors who are striking in the country a privileged class. List of high-quality authors