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On November 26, the National Medical Insurance Administration issued the "Notice on Issuing the Three-Year Action Plan for the Reform of DRG/DIP Payment Methods" (hereinafter referred to as the "Notice"), which plans to fully complete the DRG/DIP payment method reform task from 2022 to 2024
.
With the release of this policy, the industry generally believes that medical representatives will face new challenges
.
The "Notice" clarifies specific work goals and accelerates the advancement in phases and batches.
From 2022 to 2024, the task of reforming the DRG/DIP payment method will be fully completed, and the high-quality development of medical insurance will be promoted
.
By the end of 2024, all coordinated regions across the country will carry out the DRG/DIP payment method reform work, and the pilot areas will be launched in the early stage to continuously consolidate the reform results; by the end of 2025, the DRG/DIP payment method will cover all eligible medical institutions that carry out inpatient services, and it will be basically achieved Disease types and medical insurance funds are fully covered
.
The work tasks include four aspects of “grasping expansion, building mechanism, laying foundation, and promoting coordination”.
Among them, the expansion will achieve four comprehensive coverage, and it is clear that DRG/DIP will complete all coordination areas in the three years from 2022 to 2024.
As well as the coverage of medical institutions, in terms of disease coverage, the DRG/DIP paid medical institutions will achieve full coverage of diseases in DRG/DIP paid medical institutions according to a three-year arrangement.
The annual progress should be no less than 70%, 80%, and 90%, respectively.
Completed in two years
.
Encourage the enrollment rate to reach more than 90%
.
The industry pointed out that since the initial requirement of the notification for disease coverage reached 70%, it means that most departments will be covered in 2022, which may have a certain impact on the market in the short term
.
Even if most hospitals have a certain buffer period, as the original operating model changes with the advancement of payment reforms, in the next 3-5 years, the hospital market will inevitably be reshuffled
.
In addition, in terms of medical insurance fund coverage, the DRG/DIP paid medical insurance fund expenditures accounted for 70% of the inpatient medical insurance fund expenditures in the overall planning area according to a three-year arrangement, and the annual progress should be no less than 30%, 50%, and 70%, respectively.
Start in 2024 The district must be completed within two years
.
Encourage more than 70% of the total fund budget coverage
.
Judging from the proportion of DRG/DIP in the expenditure of the inpatient medical insurance fund, it can be seen that hospitals need to adapt to the payment reform, and time is limited.
If the reform cannot keep up with the progress of the reform, the survival of the hospital will face challenges
.
Mechanism construction is the core.
The notice clearly uses about three years to improve the core element management and adjustment mechanism, improve the performance management and operation monitoring mechanism, form a multi-party evaluation and dispute resolution mechanism, and establish a coordinated promotion mechanism for related reforms.
Continuously promote the connotative and refined development of the reform of medical insurance payment methods
.
Among them, the establishment of a coordinated promotion mechanism for related reforms also mentioned that it is necessary to establish a coordinated promotion mechanism for policy measures such as the "dual channel" management of drugs and the centralized procurement of pharmaceuticals and medical consumables with the national medical insurance to form a positive superimposing effect
.
The industry pointed out that this also means that after the centralized procurement, as the price of medicines and medical consumables drops, the price of the disease group (point value) should be adjusted downward accordingly
.
In general, with the announcement of the notice, the hospital will face major adjustments, and the medical representatives who have direct contact with the hospital will also face challenges
.
Under the advancement of the DRG/DIP payment method reform, the way hospitals use drugs will change, and some expensive original research drugs, unreviewed drugs, and auxiliary drugs may be blocked
.
In this context, the pressure on hospital representatives may increase.
On the one hand, they need to consider the efficacy of medicines, and on the other hand, they must pay attention to the price.
Therefore, how to survive this cold winter will be a topic for medical representatives to think about
.
.
With the release of this policy, the industry generally believes that medical representatives will face new challenges
.
The "Notice" clarifies specific work goals and accelerates the advancement in phases and batches.
From 2022 to 2024, the task of reforming the DRG/DIP payment method will be fully completed, and the high-quality development of medical insurance will be promoted
.
By the end of 2024, all coordinated regions across the country will carry out the DRG/DIP payment method reform work, and the pilot areas will be launched in the early stage to continuously consolidate the reform results; by the end of 2025, the DRG/DIP payment method will cover all eligible medical institutions that carry out inpatient services, and it will be basically achieved Disease types and medical insurance funds are fully covered
.
The work tasks include four aspects of “grasping expansion, building mechanism, laying foundation, and promoting coordination”.
Among them, the expansion will achieve four comprehensive coverage, and it is clear that DRG/DIP will complete all coordination areas in the three years from 2022 to 2024.
As well as the coverage of medical institutions, in terms of disease coverage, the DRG/DIP paid medical institutions will achieve full coverage of diseases in DRG/DIP paid medical institutions according to a three-year arrangement.
The annual progress should be no less than 70%, 80%, and 90%, respectively.
Completed in two years
.
Encourage the enrollment rate to reach more than 90%
.
The industry pointed out that since the initial requirement of the notification for disease coverage reached 70%, it means that most departments will be covered in 2022, which may have a certain impact on the market in the short term
.
Even if most hospitals have a certain buffer period, as the original operating model changes with the advancement of payment reforms, in the next 3-5 years, the hospital market will inevitably be reshuffled
.
In addition, in terms of medical insurance fund coverage, the DRG/DIP paid medical insurance fund expenditures accounted for 70% of the inpatient medical insurance fund expenditures in the overall planning area according to a three-year arrangement, and the annual progress should be no less than 30%, 50%, and 70%, respectively.
Start in 2024 The district must be completed within two years
.
Encourage more than 70% of the total fund budget coverage
.
Judging from the proportion of DRG/DIP in the expenditure of the inpatient medical insurance fund, it can be seen that hospitals need to adapt to the payment reform, and time is limited.
If the reform cannot keep up with the progress of the reform, the survival of the hospital will face challenges
.
Mechanism construction is the core.
The notice clearly uses about three years to improve the core element management and adjustment mechanism, improve the performance management and operation monitoring mechanism, form a multi-party evaluation and dispute resolution mechanism, and establish a coordinated promotion mechanism for related reforms.
Continuously promote the connotative and refined development of the reform of medical insurance payment methods
.
Among them, the establishment of a coordinated promotion mechanism for related reforms also mentioned that it is necessary to establish a coordinated promotion mechanism for policy measures such as the "dual channel" management of drugs and the centralized procurement of pharmaceuticals and medical consumables with the national medical insurance to form a positive superimposing effect
.
The industry pointed out that this also means that after the centralized procurement, as the price of medicines and medical consumables drops, the price of the disease group (point value) should be adjusted downward accordingly
.
In general, with the announcement of the notice, the hospital will face major adjustments, and the medical representatives who have direct contact with the hospital will also face challenges
.
Under the advancement of the DRG/DIP payment method reform, the way hospitals use drugs will change, and some expensive original research drugs, unreviewed drugs, and auxiliary drugs may be blocked
.
In this context, the pressure on hospital representatives may increase.
On the one hand, they need to consider the efficacy of medicines, and on the other hand, they must pay attention to the price.
Therefore, how to survive this cold winter will be a topic for medical representatives to think about
.
