Many provinces issued DRG/DIP reform plans, affecting a large number of machinery enterprises

In the new medical insurance payment method, medical consumables, medicines, etc.
have changed from profit items to cost items, and the situation of unreasonable use of consumables will be greatly improved
.
High cost performance will also become an important indicator of consumables and equipment procurement
.
For enterprises, innovative products will need to pay more attention to their real clinical value than ever before, and irreplaceability is still an important competitiveness
.
The reform of medical insurance payment has been accelerated.
Recently, Shaanxi, Fujian, Anhui, Liaoning, Inner Mongolia and other provinces have intensively released the three-year action plan for the reform of DRG/DIP payment methods to further clarify the implementation of the reform of medical insurance payment methods
.
According to the overall action plan released by the National Medical Insurance Administration in November last year, from 2022 to 2024, the reform of DRG/DIP payment methods should be fully completed to promote the high-quality development of medical insurance
.
By the end of 2024, all coordinating regions across the country will carry out the reform of DRG/DIP payment methods, and pilot areas will be launched in the early stage to continuously consolidate the reform results; Diseases and medical insurance funds are fully covered
.
On the basis of the overall action plan, the provinces have also refined some reform measures according to the actual situation
.
The pace of reform in some areas is relatively tight, and the time plan is faster than the basic requirements of the National Medical Insurance Administration
.
For example, Anhui Province plans to comprehensively carry out the DRG/DIP payment method reform in 17 co-ordination areas by the end of 2022 to achieve full coverage in the co-ordination areas; by the end of 2023, all co-ordination areas will basically achieve full coverage of eligible medical institutions, diseases and medical insurance funds.
Among them, the 14 coordinating regions that have carried out the DRG/DIP payment method reform should summarize the reform experience, improve the implementation plan, and promote the stability and sustainability of actual payment
.
It is necessary to promote the reform of payment methods in new regions
.
Bozhou, Chizhou and provincial medical insurance will carry out the reform of DRG/DIP payment method in 2022
.
Start simulated payment by the end of 2022; realize actual payment by the end of June 2023
.
Inner Mongolia Autonomous Region plans to implement DIP payment method reform in all other 11 overall planning areas in 2022 on the basis of the actual payment of national DRG pilot cities Wuhai City, DIP pilot cities Hulunbuir City, Chifeng City, and Ordos City to achieve full coverage of overall planning areas
.
After the overall planning area starts the DRG/DIP payment reform work, it will be arranged in two years to achieve full coverage of eligible medical institutions that provide inpatient services.
In 2022, it will cover second-level and above public medical institutions, and in 2023, it will cover all eligible medical institutions that provide inpatient services.
medical institution
.
In addition, various provinces and cities have also clearly deepened the reform of medical insurance payment methods in the "14th Five-Year Plan" for medical insurance
.
The "14th Five-Year Plan for Medical Insurance in Shanghai" pointed out that the guiding role of medical insurance payment on medical services should be strengthened, and medical institutions should be guided to actively control costs and strictly control the unreasonable growth of medical expenses
.
Under the framework of the total medical insurance budget, promote the formation of a "four-in-one" (DRG, DIP, bed-day, head-to-head) pattern of multiple and compound medical insurance payment methods
.
The "14th Five-Year Plan for National Medical Insurance of Sichuan Province" pointed out that the reform of DRG payment, regional point method total budget and DIP payment will be promoted, and the adjustment coefficient of traditional Chinese medicine medical institutions will be given preferential support
.
After controlling fees, how should machinery companies respond? The so-called DRG payment refers to payment according to disease diagnosis-related groups.
It divides patients into diagnosis-related groups with similar clinical symptoms and resource consumption according to factors such as disease diagnosis, disease severity, and treatment methods
.
On this basis, medical insurance pays according to the corresponding payment standard
.
DRG payment began in the United States in the 1980s.
Currently, more than 40 countries have applied it to medical insurance pricing or fund budgeting.
It is one of the more advanced and scientific payment methods recognized in the world
.
DIP payment is paid according to the score of the disease.
Under the total budget mechanism, the point value is calculated according to the total annual medical insurance payment, the proportion of medical insurance payment and the total score of cases in each medical institution to form a payment standard.
standardized payment
.
Since 2019, the National Medical Insurance Administration has successively launched a national pilot of DRG payment in 30 cities and a national pilot of DIP payment in 71 cities
.
In December 2021, the National Medical Insurance Administration identified a batch of DRG/DIP demonstration cities, and a total of 32 regions were included in the list
.
As the beginning year of the DRG/DIP payment method reform officially rolled out from a local pilot to the whole country, the impact of the reform in 2022 will also accelerate
.
The implementation of the DRG/DIP payment method is equivalent to setting a cost ceiling for the hospital.
Refinement management will become an important part of hospital construction, and downstream medical equipment companies will also face changes in the development of the industry
.
Under the new medical insurance payment system, medicines and medical consumables, which were previously profitable items, are included in the list of medical costs
.
In terms of the use of consumables, medical equipment, etc.
, under the premise of ensuring the effect of diagnosis and treatment, the consideration of high cost performance may be placed in a more important position by the hospital
.
At present, the centralized procurement work is still in progress, and a large number of high-value consumables with large clinical use and heavy burdens on patients and medical insurance are gradually reducing their prices
.
In contrast, high-quality and low-cost products will be more favored by hospitals
.
At the same time, domestic substitution in the medical industry is continuing to heat up.
In the DRG/DIP reform, the cost-effective advantage of domestic devices will be more obvious
.
If further breakthroughs can be made in key areas such as core technology and production process, domestic brands may be able to go further in this round of reform
.
Of course, whether imported or domestically produced, in the future, an obvious trend is that products with strong substitutability and relatively high prices will be at an obvious disadvantage and will be gradually screened out
.
And with irreplaceable innovative products, products with mature technology and reasonable price, its dominant position will be more prominent
.
Obviously, the new medical insurance payment method has put forward higher requirements for the medical equipment and consumables industries
.
In the new industry environment, the potential of enterprises will be more inclined to the real clinical needs of doctors and patients
.
For the layout of innovative products, the substitution value of new products for existing treatment methods should also be fully considered.
How to further improve the quality of life of patients and make the medical process safer and more efficient is also an important proposition that needs to be considered
.
In addition, blank areas where medical needs have not been met, as well as product areas where import substitution has not yet been achieved and key technologies have not yet broken through, are still important outlets for innovation
.