Many places are accelerating the exploration of TCM medical insurance payment reform!

【Pharmaceutical Network Industry News】Recently, Guangxi held a performance evaluation report meeting on the reform of medical insurance payment methods for the dominant diseases of traditional Chinese medicine
.
At the meeting, it was revealed that Guangxi has made new breakthroughs
in exploring the reform of medical insurance payment methods suitable for the characteristics of traditional Chinese medicine.
Since 2019, through the implementation of the first three-year action plan of the DRG payment reform, Guangxi has stimulated the endogenous motivation of designated medical institutions to standardize medical service behavior and control medical costs, and has achieved initial results
in guiding the rational allocation of medical resources and reducing the burden of medical expenses on the masses.
By the end of August 2022, a total of 1585 designated medical institutions in 15 co-ordinated areas in Guangxi have implemented DRG payments, covering 74.
27% of designated medical institutions and 79.
40% of inpatient medical insurance fund expenditures in
Guangxi.
It is understood that the reform of DRG/DIP medical insurance payment method is mainly to package and pay for disease cases, and through policy guidance such as "total budget, balance retention", medical institutions can be encouraged to take the initiative to control costs, standardize medical behavior, and reduce the burden on
the masses 。 Among them, Guangxi Liuzhou City, through the first trial, has actively carried out the pilot project of "Payment Methods Suitable for the Characteristics of Traditional Chinese Medicine under the Comprehensive Reform of Medical Insurance DRG Payment", and as of May to August 2022, 338 cases of curative value payment have been carried out, reducing the consumption of medical resources by nearly 2 million yuan, of which about 400,000 yuan has been reduced by the burden of medical treatment for the masses, and the balance rewards medical institutions by about 1.
6 million yuan; Carry out 3997 cases of payment for dominant diseases of traditional Chinese medicine, through the reform of medical insurance payment, medical insurance payment to traditional Chinese medicine tilt nearly 3 million In recent years, in order to further deepen the reform of medical insurance payment, promote the high-quality development of traditional Chinese medicine, and better meet people's needs for traditional Chinese medicine services, in fact, all places are accelerating the exploration of the reform of
traditional Chinese medicine medical insurance payment methods.
In addition to Guangxi, in September, the General Office of the Henan Provincial Government issued the "14th Five-Year Plan for the Development of Traditional Chinese Medicine in Henan Province", which also mentioned that Henan Province will continue to improve the price and medical insurance policies of
traditional Chinese medicine.
Explore the implementation of the TCM disease payment model according to the value of the disease, select TCM diseases, reasonably determine the score, and implement dynamic adjustment
.
At the same time, we will explore ways such as paying per capita for some chronic diseases and improve relevant technical specifications, and encourage grass-roots medical and health institutions to provide appropriate traditional Chinese medicine services
.
Eligible TCM medical institutions will be listed as designated medical institutions such as medical insurance and treatment of serious diseases
.
Appropriate TCM medical service items and Chinese medicines (including medical institution preparations, Chinese medicine tablets and Chinese medicine formula granules) will be included in the scope of
medical insurance payment in accordance with regulations 。 In August, the Shanghai Municipal Medical Insurance Bureau, the Shanghai Municipal Health Commission, the Shanghai Municipal Administration of Traditional Chinese Medicine, and the Shanghai Municipal Bureau of Finance issued the "Notice on Carrying Out the Pilot Work of Paying for the Efficacy Value of the Advantageous Diseases of Traditional Chinese Medicine", taking the principle of the same disease and the same price of traditional Chinese and Western medicine as the principle, in accordance with the principle of "outstanding advantages, clinical maturity, accurate curative effect, safe and controllable", 22 advantageous diseases of traditional Chinese medicine were identified as the first batch of pilot diseases to carry out the pilot payment according to the efficacy value, and 22 traditional Chinese medicine and integrated traditional Chinese and Western medicine hospitals were selected as the first batch of pilots
。 In July, the 45th Session of the Standing Committee of the 13th People's Congress of Guangdong Province was held
in Guangzhou.
At the meeting, the relevant person in charge said that Guangdong will deepen the reform
of medical insurance payment methods in the next step.
Comprehensively promote DRG and DIP payment in the province, and accelerate the reform
of traditional Chinese medicine medical insurance payment methods.
Promote the application of 169 kinds of inpatient diseases with advantages of traditional Chinese medicine, and promote the implementation of traditional Chinese medicine payment
by disease in accordance with the unified score database of inpatient diseases with traditional Chinese medicine advantages in the province.
In addition, Guangzhou has also included 169 inpatient diseases with advantages in traditional Chinese medicine into the scope of payment by disease score and tilted it in the score setting, promoting the clinical application of traditional Chinese medicine technology, and better playing the advantages
of traditional Chinese medicine in orthopedics, dermatology, gynecology and other specialties through the guidance of medical insurance payment methods.
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to any person.