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Medical security is a major institutional arrangement
to reduce the burden of medical treatment, improve people's livelihood and well-being, and maintain social harmony and stability.
In 2019, Anyang City became a national pilot city for national payment according to disease diagnosis related grouping (DRG), in recent years, Anyang City has faced difficulties, vigorously promoted the reform of medical insurance payment methods, made breakthroughs in solving problems such as difficult hospitalization and expensive medical treatment, realized the affordability of patients, the development of hospitals, and the sustainability of medical insurance, and created the "Anyang Model"
of medical insurance payment methods.
to reduce the burden of medical treatment, improve people's livelihood and well-being, and maintain social harmony and stability.
In 2019, Anyang City became a national pilot city for national payment according to disease diagnosis related grouping (DRG), in recent years, Anyang City has faced difficulties, vigorously promoted the reform of medical insurance payment methods, made breakthroughs in solving problems such as difficult hospitalization and expensive medical treatment, realized the affordability of patients, the development of hospitals, and the sustainability of medical insurance, and created the "Anyang Model"
of medical insurance payment methods.
Waddle on the road to build a solid foundation
Anyang city is an old industrial base
in northern Henan.
As of the end of December 2021, 4,342,500 people were insured by basic medical insurance, including 599,300 employee medical insurance and 3,743,200 resident
medical insurance.
There are 410,000 employees in the urban area, including 250,000 people who are in service and 160,000 who retire, and the ratio of job retirement is 1.
5:1, which is the lowest in the province and the burden is heavy
.
in northern Henan.
As of the end of December 2021, 4,342,500 people were insured by basic medical insurance, including 599,300 employee medical insurance and 3,743,200 resident
medical insurance.
There are 410,000 employees in the urban area, including 250,000 people who are in service and 160,000 who retire, and the ratio of job retirement is 1.
5:1, which is the lowest in the province and the burden is heavy
.
In 2019, in order to solve the dilemma, Anyang City overcame the unfavorable factors of weak economic foundation, low level of informatization and poor quality of medical data, bucked the trend, took the initiative to apply to become a national pilot city, and opened the DRG payment reform
.
.
"The Anyang medical insurance department and the medical institutions are moving in the same direction, working together, adhering to the patient-centered, adhering to respecting the clinical service, adhering to close consultation and communication, adhering to the dynamic adjustment of policies, adhering to the innovation of regulatory methods, and establishing an effective DRG payment reform work mechanism
.
" The relevant person in charge of the Municipal Medical Insurance Bureau was introduced
.
.
" The relevant person in charge of the Municipal Medical Insurance Bureau was introduced
.
The medical insurance department and medical institutions have established an evaluation and dispute handling mechanism, standardized the problem handling process, and formulated the management measures for
third-party review and rulings.
In view of the controversial diagnosis and treatment behaviors that occur in the special disease single discussion case and DRG payment, the dispute issues raised by medical institutions are accepted in a timely manner, and the disputes are eliminated through data analysis and judgment, collective discussion, consultation and negotiation, so as to properly resolve
the disputed issues.
third-party review and rulings.
In view of the controversial diagnosis and treatment behaviors that occur in the special disease single discussion case and DRG payment, the dispute issues raised by medical institutions are accepted in a timely manner, and the disputes are eliminated through data analysis and judgment, collective discussion, consultation and negotiation, so as to properly resolve
the disputed issues.
Improve policies according to local conditions
In the face of new problems in the reform, the Municipal Medical Insurance Bureau adheres to the problem-oriented, combines local realities, designs systems and adjusts policies according to local conditions, and solves the technical problems of
payment reform.
payment reform.
In order to build a complete policy system, the Municipal Medical Insurance Bureau has formulated supporting documents and management measures
such as DRG payment implementation measures, DRG payment business handling procedures, DRG paid case quality assessment methods, DRG payment assessment plans, and detailed DRG payment related policy plans.
The pilot medical institutions have also formulated various policies and systems that are compatible with DRG payment, such as the Municipal People's Hospital has formulated a clinical path management plan, cost management plan and performance appraisal plan under DRG payment, anyang Regional Hospital has specially formulated DRG payment management methods, the Municipal Cancer Hospital has formulated relevant regulations
on case quality control management, and Angang General Hospital has formulated a DRG payment implementation plan.
such as DRG payment implementation measures, DRG payment business handling procedures, DRG paid case quality assessment methods, DRG payment assessment plans, and detailed DRG payment related policy plans.
The pilot medical institutions have also formulated various policies and systems that are compatible with DRG payment, such as the Municipal People's Hospital has formulated a clinical path management plan, cost management plan and performance appraisal plan under DRG payment, anyang Regional Hospital has specially formulated DRG payment management methods, the Municipal Cancer Hospital has formulated relevant regulations
on case quality control management, and Angang General Hospital has formulated a DRG payment implementation plan.
It is not only necessary to design the system in line with reality, but also to solve problems
with reasonable distribution.
Anyang City implements the method of medical insurance fund budget and balance sharing, and the hospitalization fund implements the regional total budget, which is no longer subdivided into each medical institution, and the medical institutions in the region form a game relationship to promote medical institutions to improve the efficiency
of the use of factors.
For special cases such as emergency emergency rescue, hospitalization days greater than 60 days, extremely high costs, application of new technologies and treatment of hospital transfers for different diseases, after expert review and consultation and negotiation, determine the settlement costs of single-negotiated cases, encourage the application of new technologies and the admission and treatment of seriously ill people, and facilitate the transfer of patients in hospitals
。 At the same time, the Municipal Medical Insurance Bureau has established a settlement "balance sharing, overexpenditure sharing" mechanism, retaining the balance of a single case in a certain proportion, and appropriately compensating the cases of overspending in proportion, and the specific proportion is jointly calculated and determined by the medical insurance department and the medical institution according to the operation of the fund, and strives to compensate each case is not lower than the medical cost, so as to prevent insufficient medical services and patients
with heavy prevarication.
with reasonable distribution.
Anyang City implements the method of medical insurance fund budget and balance sharing, and the hospitalization fund implements the regional total budget, which is no longer subdivided into each medical institution, and the medical institutions in the region form a game relationship to promote medical institutions to improve the efficiency
of the use of factors.
For special cases such as emergency emergency rescue, hospitalization days greater than 60 days, extremely high costs, application of new technologies and treatment of hospital transfers for different diseases, after expert review and consultation and negotiation, determine the settlement costs of single-negotiated cases, encourage the application of new technologies and the admission and treatment of seriously ill people, and facilitate the transfer of patients in hospitals
。 At the same time, the Municipal Medical Insurance Bureau has established a settlement "balance sharing, overexpenditure sharing" mechanism, retaining the balance of a single case in a certain proportion, and appropriately compensating the cases of overspending in proportion, and the specific proportion is jointly calculated and determined by the medical insurance department and the medical institution according to the operation of the fund, and strives to compensate each case is not lower than the medical cost, so as to prevent insufficient medical services and patients
with heavy prevarication.
"We have made concerted efforts to explore more optimized reform solutions
by expanding the medical insurance settlement list, the linkage between collection and DRG, and the synergy between the medical community and DRG.
" The person in charge of the Municipal Medical Insurance Bureau was introduced
.
by expanding the medical insurance settlement list, the linkage between collection and DRG, and the synergy between the medical community and DRG.
" The person in charge of the Municipal Medical Insurance Bureau was introduced
.
The health care conundrum is solved
The actual payment of DRG for three years has achieved a win-win situation for the three parties of medicine, insurance and patients, and achieved the goal of affordable benefits for the masses, the development of hospitals, and the sustainable development
of funds.
of funds.
Solved the problem
of hospitalization.
Nowadays, the pilot medical institutions have got rid of the constraints of total amount control, and medical insurance pays drg according to the number and difficulty of the patients admitted, which effectively solves the problem of hospitalization difficulties for insured employees, and medical institutions have also made great progress
.
In 2021, the overall settlement rate of DRG payment in Anyang City was 100.
4%, and the settlement rate of 12 of the 29 pilot hospitals exceeded 100%, with a maximum of 109.
7%.
It is understood that the average cost of hospitalization in the Municipal People's Hospital in 2021 fell by 1500 yuan, and the medical income decreased by 100 million yuan, but through structural adjustment, the proportion of drugs decreased, the proportion of medical service income increased, and the disposable income increased by 41.
03 million yuan
.
of hospitalization.
Nowadays, the pilot medical institutions have got rid of the constraints of total amount control, and medical insurance pays drg according to the number and difficulty of the patients admitted, which effectively solves the problem of hospitalization difficulties for insured employees, and medical institutions have also made great progress
.
In 2021, the overall settlement rate of DRG payment in Anyang City was 100.
4%, and the settlement rate of 12 of the 29 pilot hospitals exceeded 100%, with a maximum of 109.
7%.
It is understood that the average cost of hospitalization in the Municipal People's Hospital in 2021 fell by 1500 yuan, and the medical income decreased by 100 million yuan, but through structural adjustment, the proportion of drugs decreased, the proportion of medical service income increased, and the disposable income increased by 41.
03 million yuan
.
Alleviates the problem
of expensive medical treatment.
In 2021, Anyang Became the only prefecture-level city in Henan Province to achieve a decline in the total purchase price of drugs by public medical institutions, and the average hospitalization cost of the 14 pilot medical institutions in the urban area was 10,468 yuan, down 5.
52% from 11,080 yuan in 2018 before the reform, achieving zero growth in the average cost of three years; The actual medical expenses per unit weight decreased from 10862.
35 yuan in 2019 to 8227.
14 yuan in 2021, and the personal burden rate of insured patients decreased by 2%.
The unreasonable and rapid growth of medical expenses in Anyang has been effectively curbed, and the problem of expensive medical treatment has been effectively alleviated
.
Taking coronary stents as an example, in 2021, 7 medical institutions in the urban area used 3362 coronary stents and 6198 person-times, with an average hospitalization cost of 27814 yuan, down 18174 yuan from 45988 yuan in 2020, and this one group alone reduced medical expenses by 61 million yuan
.
of expensive medical treatment.
In 2021, Anyang Became the only prefecture-level city in Henan Province to achieve a decline in the total purchase price of drugs by public medical institutions, and the average hospitalization cost of the 14 pilot medical institutions in the urban area was 10,468 yuan, down 5.
52% from 11,080 yuan in 2018 before the reform, achieving zero growth in the average cost of three years; The actual medical expenses per unit weight decreased from 10862.
35 yuan in 2019 to 8227.
14 yuan in 2021, and the personal burden rate of insured patients decreased by 2%.
The unreasonable and rapid growth of medical expenses in Anyang has been effectively curbed, and the problem of expensive medical treatment has been effectively alleviated
.
Taking coronary stents as an example, in 2021, 7 medical institutions in the urban area used 3362 coronary stents and 6198 person-times, with an average hospitalization cost of 27814 yuan, down 18174 yuan from 45988 yuan in 2020, and this one group alone reduced medical expenses by 61 million yuan
.
Kept the life-saving money
.
The medical insurance fund is the people's medical treatment money and life-saving money, and it must be managed and used well
.
Anyang City has insisted on adapting to the DRG payment reform in various forms of fund supervision, and has achieved obvious results
.
Through innovative supervision methods, third-party institutions are hired to supervise, and a third-party audit service center of the medical insurance fund is established to provide services such as DRG payment audit, fund operation risk warning, medical insurance anti-fraud supervision, etc.
, and implement a performance incentive mechanism to incentivize payment proportionally according to the amount of violations detected, ensuring the safe and reasonable use of
the medical insurance fund.
According to statistics, in the past three years, Anyang City has recovered a total of 94.
73 million yuan
of medical insurance funds.
In addition, Anyang City expanded the scope of monitoring, carried out intelligent audits, and formed a long-term mechanism for
monitoring, punishing, and rectifying medical violations.
In 2020 and 2021, the Anyang Medical Insurance Pooling Fund has a total balance of nearly 1 billion yuan, and the operation of the fund continues to be stable, keeping the people's life-saving money
.
.
The medical insurance fund is the people's medical treatment money and life-saving money, and it must be managed and used well
.
Anyang City has insisted on adapting to the DRG payment reform in various forms of fund supervision, and has achieved obvious results
.
Through innovative supervision methods, third-party institutions are hired to supervise, and a third-party audit service center of the medical insurance fund is established to provide services such as DRG payment audit, fund operation risk warning, medical insurance anti-fraud supervision, etc.
, and implement a performance incentive mechanism to incentivize payment proportionally according to the amount of violations detected, ensuring the safe and reasonable use of
the medical insurance fund.
According to statistics, in the past three years, Anyang City has recovered a total of 94.
73 million yuan
of medical insurance funds.
In addition, Anyang City expanded the scope of monitoring, carried out intelligent audits, and formed a long-term mechanism for
monitoring, punishing, and rectifying medical violations.
In 2020 and 2021, the Anyang Medical Insurance Pooling Fund has a total balance of nearly 1 billion yuan, and the operation of the fund continues to be stable, keeping the people's life-saving money
.
Through the three-year DRG payment reform, Anyang City has truly realized the affordability of patients, the development of hospitals, and the sustainability
of funds.
In December 2021, Anyang City was identified by the National Medical Insurance Bureau as a DRG payment demonstration point, becoming a "punch card" for the exchange of medical insurance system work, known as the "Anyang Model"
.
(Contributed by the Propaganda Department of the Anyang Municipal CPC Committee, correspondent Xu Meimei, Hui Hailiang)
of funds.
In December 2021, Anyang City was identified by the National Medical Insurance Bureau as a DRG payment demonstration point, becoming a "punch card" for the exchange of medical insurance system work, known as the "Anyang Model"
.
(Contributed by the Propaganda Department of the Anyang Municipal CPC Committee, correspondent Xu Meimei, Hui Hailiang)
Medical security is a major institutional arrangement
to reduce the burden of medical treatment, improve people's livelihood and well-being, and maintain social harmony and stability.
In 2019, Anyang City became a national pilot city for national payment according to disease diagnosis related grouping (DRG), in recent years, Anyang City has faced difficulties, vigorously promoted the reform of medical insurance payment methods, made breakthroughs in solving problems such as difficult hospitalization and expensive medical treatment, realized the affordability of patients, the development of hospitals, and the sustainability of medical insurance, and created the "Anyang Model"
of medical insurance payment methods.
to reduce the burden of medical treatment, improve people's livelihood and well-being, and maintain social harmony and stability.
In 2019, Anyang City became a national pilot city for national payment according to disease diagnosis related grouping (DRG), in recent years, Anyang City has faced difficulties, vigorously promoted the reform of medical insurance payment methods, made breakthroughs in solving problems such as difficult hospitalization and expensive medical treatment, realized the affordability of patients, the development of hospitals, and the sustainability of medical insurance, and created the "Anyang Model"
of medical insurance payment methods.
Waddle on the road to build a solid foundation
Waddle on the road to build a solid foundation Anyang city is an old industrial base
in northern Henan.
As of the end of December 2021, 4,342,500 people were insured by basic medical insurance, including 599,300 employee medical insurance and 3,743,200 resident
medical insurance.
There are 410,000 employees in the urban area, including 250,000 people who are in service and 160,000 who retire, and the ratio of job retirement is 1.
5:1, which is the lowest in the province and the burden is heavy
.
in northern Henan.
As of the end of December 2021, 4,342,500 people were insured by basic medical insurance, including 599,300 employee medical insurance and 3,743,200 resident
medical insurance.
There are 410,000 employees in the urban area, including 250,000 people who are in service and 160,000 who retire, and the ratio of job retirement is 1.
5:1, which is the lowest in the province and the burden is heavy
.
In 2019, in order to solve the dilemma, Anyang City overcame the unfavorable factors of weak economic foundation, low level of informatization and poor quality of medical data, bucked the trend, took the initiative to apply to become a national pilot city, and opened the DRG payment reform
.
.
"The Anyang medical insurance department and the medical institutions are moving in the same direction, working together, adhering to the patient-centered, adhering to respecting the clinical service, adhering to close consultation and communication, adhering to the dynamic adjustment of policies, adhering to the innovation of regulatory methods, and establishing an effective DRG payment reform work mechanism
.
" The relevant person in charge of the Municipal Medical Insurance Bureau was introduced
.
.
" The relevant person in charge of the Municipal Medical Insurance Bureau was introduced
.
The medical insurance department and medical institutions have established an evaluation and dispute handling mechanism, standardized the problem handling process, and formulated the management measures for
third-party review and rulings.
In view of the controversial diagnosis and treatment behaviors that occur in the special disease single discussion case and DRG payment, the dispute issues raised by medical institutions are accepted in a timely manner, and the disputes are eliminated through data analysis and judgment, collective discussion, consultation and negotiation, so as to properly resolve
the disputed issues.
third-party review and rulings.
In view of the controversial diagnosis and treatment behaviors that occur in the special disease single discussion case and DRG payment, the dispute issues raised by medical institutions are accepted in a timely manner, and the disputes are eliminated through data analysis and judgment, collective discussion, consultation and negotiation, so as to properly resolve
the disputed issues.
Improve policies according to local conditions
Improve policies according to local conditions In the face of new problems in the reform, the Municipal Medical Insurance Bureau adheres to the problem-oriented, combines local realities, designs systems and adjusts policies according to local conditions, and solves the technical problems of
payment reform.
payment reform.
In order to build a complete policy system, the Municipal Medical Insurance Bureau has formulated supporting documents and management measures
such as DRG payment implementation measures, DRG payment business handling procedures, DRG paid case quality assessment methods, DRG payment assessment plans, and detailed DRG payment related policy plans.
The pilot medical institutions have also formulated various policies and systems that are compatible with DRG payment, such as the Municipal People's Hospital has formulated a clinical path management plan, cost management plan and performance appraisal plan under DRG payment, anyang Regional Hospital has specially formulated DRG payment management methods, the Municipal Cancer Hospital has formulated relevant regulations
on case quality control management, and Angang General Hospital has formulated a DRG payment implementation plan.
Tumor tumorssuch as DRG payment implementation measures, DRG payment business handling procedures, DRG paid case quality assessment methods, DRG payment assessment plans, and detailed DRG payment related policy plans.
The pilot medical institutions have also formulated various policies and systems that are compatible with DRG payment, such as the Municipal People's Hospital has formulated a clinical path management plan, cost management plan and performance appraisal plan under DRG payment, anyang Regional Hospital has specially formulated DRG payment management methods, the Municipal Cancer Hospital has formulated relevant regulations
on case quality control management, and Angang General Hospital has formulated a DRG payment implementation plan.
It is not only necessary to design the system in line with reality, but also to solve problems
with reasonable distribution.
Anyang City implements the method of medical insurance fund budget and balance sharing, and the hospitalization fund implements the regional total budget, which is no longer subdivided into each medical institution, and the medical institutions in the region form a game relationship to promote medical institutions to improve the efficiency
of the use of factors.
For special cases such as emergency emergency rescue, hospitalization days greater than 60 days, extremely high costs, application of new technologies and treatment of hospital transfers for different diseases, after expert review and consultation and negotiation, determine the settlement costs of single-negotiated cases, encourage the application of new technologies and the admission and treatment of seriously ill people, and facilitate the transfer of patients in hospitals
。 At the same time, the Municipal Medical Insurance Bureau has established a settlement "balance sharing, overexpenditure sharing" mechanism, retaining the balance of a single case in a certain proportion, and appropriately compensating the cases of overspending in proportion, and the specific proportion is jointly calculated and determined by the medical insurance department and the medical institution according to the operation of the fund, and strives to compensate each case is not lower than the medical cost, so as to prevent insufficient medical services and patients
with heavy prevarication.
Diseases and diseaseswith reasonable distribution.
Anyang City implements the method of medical insurance fund budget and balance sharing, and the hospitalization fund implements the regional total budget, which is no longer subdivided into each medical institution, and the medical institutions in the region form a game relationship to promote medical institutions to improve the efficiency
of the use of factors.
For special cases such as emergency emergency rescue, hospitalization days greater than 60 days, extremely high costs, application of new technologies and treatment of hospital transfers for different diseases, after expert review and consultation and negotiation, determine the settlement costs of single-negotiated cases, encourage the application of new technologies and the admission and treatment of seriously ill people, and facilitate the transfer of patients in hospitals
。 At the same time, the Municipal Medical Insurance Bureau has established a settlement "balance sharing, overexpenditure sharing" mechanism, retaining the balance of a single case in a certain proportion, and appropriately compensating the cases of overspending in proportion, and the specific proportion is jointly calculated and determined by the medical insurance department and the medical institution according to the operation of the fund, and strives to compensate each case is not lower than the medical cost, so as to prevent insufficient medical services and patients
with heavy prevarication.
"We have made concerted efforts to explore more optimized reform solutions
by expanding the medical insurance settlement list, the linkage between collection and DRG, and the synergy between the medical community and DRG.
" The person in charge of the Municipal Medical Insurance Bureau was introduced
.
by expanding the medical insurance settlement list, the linkage between collection and DRG, and the synergy between the medical community and DRG.
" The person in charge of the Municipal Medical Insurance Bureau was introduced
.
The health care conundrum is solved
The health care conundrum is solved The actual payment of DRG for three years has achieved a win-win situation for the three parties of medicine, insurance and patients, and achieved the goal of affordable benefits for the masses, the development of hospitals, and the sustainable development
of funds.
of funds.
Solved the problem
of hospitalization.
Nowadays, the pilot medical institutions have got rid of the constraints of total amount control, and medical insurance pays drg according to the number and difficulty of the patients admitted, which effectively solves the problem of hospitalization difficulties for insured employees, and medical institutions have also made great progress
.
In 2021, the overall settlement rate of DRG payment in Anyang City was 100.
4%, and the settlement rate of 12 of the 29 pilot hospitals exceeded 100%, with a maximum of 109.
7%.
It is understood that the average cost of hospitalization in the Municipal People's Hospital in 2021 fell by 1500 yuan, and the medical income decreased by 100 million yuan, but through structural adjustment, the proportion of drugs decreased, the proportion of medical service income increased, and the disposable income increased by 41.
03 million yuan
.
of hospitalization.
Nowadays, the pilot medical institutions have got rid of the constraints of total amount control, and medical insurance pays drg according to the number and difficulty of the patients admitted, which effectively solves the problem of hospitalization difficulties for insured employees, and medical institutions have also made great progress
.
In 2021, the overall settlement rate of DRG payment in Anyang City was 100.
4%, and the settlement rate of 12 of the 29 pilot hospitals exceeded 100%, with a maximum of 109.
7%.
It is understood that the average cost of hospitalization in the Municipal People's Hospital in 2021 fell by 1500 yuan, and the medical income decreased by 100 million yuan, but through structural adjustment, the proportion of drugs decreased, the proportion of medical service income increased, and the disposable income increased by 41.
03 million yuan
.
Alleviates the problem
of expensive medical treatment.
In 2021, Anyang Became the only prefecture-level city in Henan Province to achieve a decline in the total purchase price of drugs by public medical institutions, and the average hospitalization cost of the 14 pilot medical institutions in the urban area was 10,468 yuan, down 5.
52% from 11,080 yuan in 2018 before the reform, achieving zero growth in the average cost of three years; The actual medical expenses per unit weight decreased from 10862.
35 yuan in 2019 to 8227.
14 yuan in 2021, and the personal burden rate of insured patients decreased by 2%.
The unreasonable and rapid growth of medical expenses in Anyang has been effectively curbed, and the problem of expensive medical treatment has been effectively alleviated
.
Taking coronary stents as an example, in 2021, 7 medical institutions in the urban area used 3362 coronary stents and 6198 person-times, with an average hospitalization cost of 27814 yuan, down 18174 yuan from 45988 yuan in 2020, and this one group alone reduced medical expenses by 61 million yuan
.
Procurement of pharmaceuticals and pharmaceuticalsof expensive medical treatment.
In 2021, Anyang Became the only prefecture-level city in Henan Province to achieve a decline in the total purchase price of drugs by public medical institutions, and the average hospitalization cost of the 14 pilot medical institutions in the urban area was 10,468 yuan, down 5.
52% from 11,080 yuan in 2018 before the reform, achieving zero growth in the average cost of three years; The actual medical expenses per unit weight decreased from 10862.
35 yuan in 2019 to 8227.
14 yuan in 2021, and the personal burden rate of insured patients decreased by 2%.
The unreasonable and rapid growth of medical expenses in Anyang has been effectively curbed, and the problem of expensive medical treatment has been effectively alleviated
.
Taking coronary stents as an example, in 2021, 7 medical institutions in the urban area used 3362 coronary stents and 6198 person-times, with an average hospitalization cost of 27814 yuan, down 18174 yuan from 45988 yuan in 2020, and this one group alone reduced medical expenses by 61 million yuan
.
Kept the life-saving money
.
The medical insurance fund is the people's medical treatment money and life-saving money, and it must be managed and used well
.
Anyang City has insisted on adapting to the DRG payment reform in various forms of fund supervision, and has achieved obvious results
.
Through innovative supervision methods, third-party institutions are hired to supervise, and a third-party audit service center of the medical insurance fund is established to provide services such as DRG payment audit, fund operation risk warning, medical insurance anti-fraud supervision, etc.
, and implement a performance incentive mechanism to incentivize payment proportionally according to the amount of violations detected, ensuring the safe and reasonable use of
the medical insurance fund.
According to statistics, in the past three years, Anyang City has recovered a total of 94.
73 million yuan
of medical insurance funds.
In addition, Anyang City expanded the scope of monitoring, carried out intelligent audits, and formed a long-term mechanism for
monitoring, punishing, and rectifying medical violations.
In 2020 and 2021, the Anyang Medical Insurance Pooling Fund has a total balance of nearly 1 billion yuan, and the operation of the fund continues to be stable, keeping the people's life-saving money
.
.
The medical insurance fund is the people's medical treatment money and life-saving money, and it must be managed and used well
.
Anyang City has insisted on adapting to the DRG payment reform in various forms of fund supervision, and has achieved obvious results
.
Through innovative supervision methods, third-party institutions are hired to supervise, and a third-party audit service center of the medical insurance fund is established to provide services such as DRG payment audit, fund operation risk warning, medical insurance anti-fraud supervision, etc.
, and implement a performance incentive mechanism to incentivize payment proportionally according to the amount of violations detected, ensuring the safe and reasonable use of
the medical insurance fund.
According to statistics, in the past three years, Anyang City has recovered a total of 94.
73 million yuan
of medical insurance funds.
In addition, Anyang City expanded the scope of monitoring, carried out intelligent audits, and formed a long-term mechanism for
monitoring, punishing, and rectifying medical violations.
In 2020 and 2021, the Anyang Medical Insurance Pooling Fund has a total balance of nearly 1 billion yuan, and the operation of the fund continues to be stable, keeping the people's life-saving money
.
Through the three-year DRG payment reform, Anyang City has truly realized the affordability of patients, the development of hospitals, and the sustainability
of funds.
In December 2021, Anyang City was identified by the National Medical Insurance Bureau as a DRG payment demonstration point, becoming a "punch card" for the exchange of medical insurance system work, known as the "Anyang Model"
.
(Contributed by the Propaganda Department of the Anyang Municipal CPC Committee, correspondent Xu Meimei, Hui Hailiang)
Hospital Hospital of funds.
In December 2021, Anyang City was identified by the National Medical Insurance Bureau as a DRG payment demonstration point, becoming a "punch card" for the exchange of medical insurance system work, known as the "Anyang Model"
.
(Contributed by the Propaganda Department of the Anyang Municipal CPC Committee, correspondent Xu Meimei, Hui Hailiang)
