DRGs and then the next city 115 national harvest varieties ushered in a big good auxiliary drug and then meet the attack

Senior DRGs researchers said, "This time the document is a fixed rule, equivalent to laying the foundation for a full pilot next year."
" From 2018, when the Health Care Administration issued the Notice on the Declaration of National Pilots for Paying by Groups Related to Disease Diagnosis (No. 27), the DRGs Pay Pilot was officially taken over by the Health Insurance Administration, which published a list of 30 pilot cities by 2019, followed by the release of the CHS-DRG Subgroup Program to complete the standard action.
DRG is a kind of fixed-rate payment method packaged by the disease group, patient treatment costs "one mouth price" packaging charges, large prescriptions, large examinations, misuse of supplies and other acts, will increase the cost of the hospital, rather than improve profits, so DRG payment will make the hospital in the premise of ensuring the quality of care, to minimize expenditure, reduce costs, improve efficiency.
the Big Diagnosis Data-Intervention Packet, DIP, which was announced in this scenario, is actually the big data DRGs of the past, which are automatically grouped based on diagnostics and actions based on full sample data.
based on objective data, the disease is formed directly by the natural combination of the main diagnosis and associated surgical operation.
the biggest difference between DIP and DRGs is that the grouping method is different, DIP is simpler, its settlement unit is the group, and the DRGs settlement unit is the sub-group below the group, which is relatively more complex.
, Guangdong Province, is a typical DIP pilot city.
the Foshan Medical Insurance Bureau disclosed that in the first half of 2019, the city's average total cost growth rate of 0.44%, down 90% YoY, the city's unreasonable growth in medical expenses has been effectively controlled.
and the regional points method make hospitals compete with each other, greatly increasing the willingness of hospitals to participate.
" for pharmaceutical companies, whether DRGs or DIP, will completely change the pattern of drug use in hospitals.
for the winning variety of strip procurement, its price advantage and economic security to give it more opportunities, and for a large number of auxiliary drugs, high-value supplies, etc. will be the disaster.
" like benzodialycerine is the latest winning bid is 0.15 yuan per tablet, and now some manufacturers can maintain the price of 1.2 yuan a piece, for this kind of drugs, but with the development of DRGs policy, this huge price gap will no longer exist.
the DRGs policy, whether active embrace or passive acceptance, will be fully implemented in 2021, the health care payment model reform driven by industry change has arrived.
In fact, Guoxin Securities has previously mentioned the impact on pharmaceutical companies, Guoxin Securities pharmaceutical industry chief analyst Xie Changxuan believes that the start of DRGs in 2021, the actual payment will have a far-reaching impact on clinical diagnosis and treatment, medical insurance charges, strong consumer attributes, emergency use Drugs, end-stage treatment and outpatient drug varieties are not affected, and under the cost-benefit assessment will promote ICL (third-party independent medical laboratory) penetration and IVD industry import substitution, the core upstream resources (raw material equipment, patented raw materials) will also be increased.
The exploration course of DrGs in China is accompanied by the following full text (target key points and comments): Annex: Total budget of the regional points method and payment by disease value-for-money Pilot Work Programme In order to implement the Opinions of the CPC Central Committee and the State Council on Deepening the Reform of the Health Care System, we will continue to push forward the reform of the payment method of medical insurance, improve the transparency of medical services, improve the efficiency of the use of medical insurance funds, and formulate this plan.
, the overall requirements (i) guiding ideology.
Guided by Xi Jinping's thought of socialism with Chinese characteristics in the new era, we will fully implement the spirit of the Second, Third and Fourth Plenary Sessions of the 19th National Congress of the Communist Party of China and the 19th Central Committee of the Communist Party of China, take people's health as the center, give full play to the strategic purchasing role of medical insurance funds, better rely on designated medical institutions to provide medical services to insured persons, improve the performance of the use of medical insurance funds, and improve the level of fine management services for medical insurance.
(ii) basic principles.
people as the center, combine the points method with the regional total budget, promote the effective use of medical resources, and focus on safeguarding the basic medical needs of the insured.
to adhere to transparency and efficiency, with objective data as the support, fully reflect the output of medical services, mobilize the enthusiasm of medical personnel.
to respect the law of medical care, the implementation of multi-composite payment methods, to achieve full coverage of hospital medical expenses.
to maintain dynamic maintenance, multi-party communication and consultation, improve the disease combination directory, disease score and other dynamic maintenance mechanism.
(iii) pilot objectives.
1-2 years, the total budget of regional medical insurance will be combined with the point method to achieve a multi-composite payment method based on the division of diseases in hospital.
establish a modern data governance mechanism to form the data collection, storage, use of norms and standards.
to gradually establish a system of payment for medical services based on diseases, results-oriented, and improve the communication and negotiation mechanism between medical insurance and medical institutions.
strengthen the quantitative assessment based on the disease, so that medical behavior can be quantified and compared.
can be used for reference, replicable and replicable experience, so as to set the foundation for the next step in a wider range of promotion.
, pilot scope and requirements to the city-level co-ordination area as a unit.
The pilot cities should meet the following conditions: the local government attaches great importance to and supports the pilot work, has a strong willingness to participate in the reform of the big data-based disease score payment method or has carried out the work of the disease score payment; To promote the pilot in an integrated manner; the pilot cities have made real basic medical insurance city-level co-ordination, and in recent years, the basic balance of income and expenditure; the medical insurance management agency has strong organizational and management service capabilities, and has the basic conditions for the use of the national unified medical insurance information business code, such as disease diagnosis and surgical operation, medicine, medical supplies, medical service items, medical insurance settlement list, etc.
(review: the original scope of the re-expansion of the country's regions.
can be incorporated on a district-level basis, but the initiative in the provincial health insurance bureaus, there is the will, ability, conditions, and foundation of the first.
) The State Health Insurance Administration is responsible for formulating the pilot work programme, proposing criteria for selecting and monitoring pilot cities, improving the consultation and negotiation mechanism and guiding the pilot work in various places.
provincial health insurance departments are responsible for the selection, identification, training, guidance and assessment of pilot cities.
The National Institute of Medical Security of Capital Medical University was commissioned by the National Health Insurance Bureau to organize experts to set up technical guidance groups to assist our Bureau in formulating technical specifications, group schemes and management methods for paying according to the value of diseases, and to provide technical support for the pilot work carried out by the local medical insurance departments.
, the pilot content (1) the implementation of regional total budget management.
In accordance with the principle of collecting expenditure, balancing income and expenditure, with a slight balance, and taking into account all kinds of expenditure risks, the overall consideration of price levels, medical consumption behavior of insured persons, total growth rate and other factors, establish and improve the consultation and negotiation mechanism between medical insurance agencies and fixed-point medical institutions, and reasonably determine the budget target of total medical insurance.
No longer refine and clarify the total control indicators of each medical institution, but to convert the items, diseases, bed days and other payment units into a fixed number, at the end of the year according to the total number of points provided by each medical institution and the regional medical insurance fund expenditure budget indicators, to arrive at the actual value of each point, according to the actual points of each medical institution to pay.
(review: the advantage of the points method is that the hospitals can not predict the amount of health care funds that have been awarded before the implementation, avoiding the situation of pushing patients) (ii) to achieve full coverage of hospitalization cases.
the national level to determine the classification of disease species, the core and comprehensive disease classification criteria.
the pilot cities, according to local data, in accordance with the unified rules of disease combination, the formation of their respective cities' disease species score directory core diseases and comprehensive diseases library.
the pilot cities to determine the score of core diseases based on the average medical cost of full sample data cases in the first 3 years of the region.
for cases with comprehensive diseases and abnormally high values, the disease score can be determined by means of case review, expert review, etc.
for cases with abnormally low values, the disease score is determined at actual cost.
to determine the use of bed-day payments in cases where hospital stays are longer, such as psychiatric, rehabilitation and tranquillity treatment.
(review: good with the volume of procurement varieties, on the one hand, can complete the national task to get the "residual retention" of money, on the other hand, but also for DIP and DRG to save a part of the cost.
) (iii) To formulate a matching settlement method.
according to the characteristics of paying according to the disease score, improve the corresponding medical insurance procedures and protocol management process.
the medical insurance agency shall, in accordance with the total amount of expenditure on the budget of the fund for the current year, advance certain periodic funds (in principle, one month) and settle them by point during the period.
the pilot cities to carry out disease cost measurement, classification summary of disease and cost data, according to the average cost of each disease and other factors to calculate the score.
the floating mechanism of the score, introduce the grade coefficient of medical institutions, distinguish the score of different levels of medical institutions, and adjust it dynamically.
the standards for the score of diseases suitable for diagnosis and treatment at the grass-roots medical institutions and capable of diagnosis and treatment at the grass-roots level should be consistent at different levels of medical institutions.
the end of the year to carry out performance appraisal of medical institutions, in accordance with the agreement to link performance appraisal with year-end liquidation.
(comments: settlement methods directly affect the use of specific products, high-value products will usher in a wave of "suppression", especially auxiliary drugs and high-value supplies.
) (iv) Build a data center.
, on the basis of having the business code of using the relevant medical insurance information unified throughout the country, carry out quality control work such as the medical insurance settlement list and the medical insurance expense schedule.
strengthen capacity-building in data governance and formulate relevant management measures for data filling, collection, transmission, storage and use.
carry out the dynamic maintenance, coding mapping and related interface transformation of the database of the medical insurance information system, so as to lay the foundation for the reform of the payment method of medical insurance and the refinement of the management of medical insurance.
:Data Unification, laying the foundation for the national pilot.
) (v) Strengthen supporting regulatory measures.
the characteristics of medical services paid for by diseases, give full play to the role of big data, formulate relevant regulatory indicators, and implement big data-based supervision.
strengthen the quantitative assessment based on disease, promote the transparency of regional medical services, avoid high-set coding, punch points and other behavior.
to strengthen surveillance of key diseases to ensure the quality of medical care.
(vi) to improve the management of the agreement.
the pilot areas shall standardize the local protocol text, improve the relevant content of paying according to the value of the disease, specify the total budget, data reporting, grouping, settlement, etc., and strengthen medical behavior, service efficiency and so on.
the rights and responsibilities of medical institutions, agencies and other institutions, and implement relevant standards and systems.
(vii) to strengthen professional and technical capacity-building.
establishment of medical insurance institutions, medical institutions, as well as universities, scientific research institutions, such as the formation of a team of experts.
to ensure quality, control costs, standardize diagnosis and treatment, improve the enthusiasm of medical personnel as the core of the pay-per-disease and performance management system.
to explore the total cost of outpatient by person, by project, close-knit medical community into points, and with the inpatient service points to form a comparable relationship, to achieve the total regional point method budget.
, implementation steps (i) registration stage.
mid-October 2020, the provincial (district, city) health insurance bureaus, taking into account the conditions of the pilot cities, select the eligible cities, and form an application report to be submitted to the National Health Insurance Administration.
(ii) the preparation phase.
by the end of October 2020, the National Health Insurance Administration will assess and determine the list of pilot cities.
the framework of the national portfolio of diseases and related basic standards.
October-November 2020, the pilot cities usually report historical data, and the National Health Insurance Administration will use the pilot city data to form localized groups of diseases.
to carry out training in national pilot technical specifications, guide pilot cities to master the combination of diseases, the basic principles and methods of paying for points, and improve the supporting documents for the national pilot of diseases.
combined with the construction of the national medical insurance information platform, in accordance with the latest technical standards and unified medical insurance information business coding standards, by the pilot cities to improve the information interface with the pilot medical institutions transformation, real-time collection of required data.
(iii) payment stage.
December 2020, pilot cities will use real-time data and localized grouping schemes to pre-group and prepare for paid technology.
from March 2021, according to the technical preparation and supporting policy formulation of the pilot areas, the eligible regions can start the actual payment before filing, and by the end of 2021, all the pilot areas will have entered the actual payment phase.
, the pilot safeguard mechanism (i) organization leadership mechanism.
health insurance departments in the pilot cities are mainly responsible for comrades to lead the establishment of pilot leading institutions, designated a person responsible for the pilot work, the organization of technical experts, the full implementation of the pilot tasks and requirements.
pilot cities should fully mobilize the enthusiasm of medical institutions, establish communication and consultation mechanisms with medical institutions to ensure the smooth progress of the pilot.
(ii) periodic reporting mechanism.
The medical insurance departments in the pilot areas shall regularly summarize the progress and effectiveness of the work, form a phased report, and report it to the State Health Insurance Administration (notice separately) in accordance with the prescribed time, including the progress of basic preparatory work such as dynamic maintenance of the local disease portfolio catalogue and the measurement of the cost-between criteria, as well as the implementation of specific organizations and the effectiveness of the implementation.
(iii) monitoring and evaluation mechanism.
The experts organized by the State Medical Insurance Administration conduct follow-up evaluation, monitor the progress of the work of paying according to the value of diseases in the pilot areas, monitor the operation of the medical insurance fund, and evaluate the effect of the implementation of the payment by the fine management capacity and service level of medical insurance, the transformation of the operating mechanism of medical institutions, and the benefits of the insured.
(iv) learning and communication mechanism.
to strengthen exchanges and learning among the pilot areas, sum up the pilot experience practices in a timely manner, form typical cases, and publicize the main practices, phased results and supporting policy provisions of the advanced regions