Monitoring report authoritative release! How's the drG paid for by piloting more than half of it?

Wen | China's medical insurance dream continues to promote the reform of medical insurance payment methods, explore the fine management model, which is the core of improving the payment mechanism of medical insurance, but also to strengthen the reform of health insurance, medical care linkage is an important means.
This work has been on the agenda since the establishment of the National Health Insurance Administration, and at this stage, the general direction of reform is to explore more refined composite and diversified payment methods under the existing total budget system, including payment by disease diagnosis-related grouping (DRG), total regional points budget and payment by disease score (DIP).
the National Health Insurance Administration officially launched its pay-per-view (DRG)-related work at the end of 2018, and in May 2019 announced a list of 30 DRG-paid pilot cities, deploying "top-level design, simulation testing, The actual payment "three years and three steps of the pilot overall arrangement, with a view to achieving the "set of standards, improve a series of policies, establish a set of procedures, train a team, build a number of models" goal, in order to fully push the DRG pay a good foundation.
2020 is the second year in which countries have organized paid national pilots for disease diagnosis-related subgroups (DRGs), substantial progress has been made in the design of top-level systems at the national level and in the exploration and practice at the local level.
In the process of promoting the national pilot work, the National Institute of Medical Security of capital medical university (the "Medical Insurance Research Institute") was commissioned by the Medical Services Management Department of the National Health Insurance Administration to monitor in real time the landing of the DRG paid national pilot projects in the pilot cities.
in accordance with the "top-level design, simulation testing, actual payment" three-step thinking, this year the pilot cities should enter the "simulation test" stage.
, how's the DRG pay-per-view pilot going? How are the pilot cities progressing, are they able to meet the policy's design objectives, and what are the problems encountered? On November 11th, at the "DRG Paid National Pilot City Payment Reform Forum" held in Wuhan, the Institute of Health Care Research released the "DrG Paid National Pilot Monitoring Assessment Report for the Third Quarter of 2020", which includes the overall progress of the pilot city, experience and bright spots, key issues and the next steps, giving full play to the role of urging the pilot cities to speed up the pilot work, and providing reference and reference for promoting the DRG paid national pilot work.
technical guidance and training on the problems existing in the pilot process by experts from the special technical guidance group of the national DRG payment.
Health Insurance Research Institute in response to The Deputy President of Yazhen in the field report pointed out that, according to the specific requirements of the pilot work, the monitoring of 30 countries pilot cities of the sub-grouping program, payment standards, settlement rules, supporting regulatory assessment and indicator system and other aspects of the assessment.
results show that, as of the third quarter of 2020, the pilot city pilot progress, although there are significant differences, but compared with last year, there is significant progress.
overall, 29 of the 30 pilot cities are basically in line with national deployment requirements and have the conditions for simulated operation.
Of these, 7 cities had actually paid for the simulation before the pilot, and 22 had been prepared to have the conditions for the simulation operation after the pilot started, including 2 cities that had actually paid for the simulation operation after the pilot, 4 cities that had entered the simulation operation phase and 16 cities that had been eligible but had not yet entered the simulation operation.
, the grouping technology methods and settlement rules of individual pilot cities are not perfect enough and need further adjustment and improvement.
the pilot cities in the process of policy landing problems, summarized as common problems and personality issues.
At present, the progress of the pilot cities is not the same, so the next step should also be combined with their own actual situation to arrange, according to the medical insurance research institute monitoring and evaluation report, the current pilot city's work schedule can be divided into the following four situations: the national DRG payment special technical guidance group leader Zheng Jie said that DRG payment itself is a very test of the health insurance sector and medical institutions infrastructure work, want to make it impossible to complete overnight.
Even though uniform technical norms and guidelines have been put in place at the national level, it is normal for progress and level to occur in preparation for related work, as infrastructure varies widely from place to place and each faces historical legacies that have accumulated over the years.
From the perspective of the national DRG payment special technical guidance group, the pilot cities in the preparation of DRG payment pilot work, in addition to the management mechanism level, but also pay attention to the combination of rationality, data quality and other technical aspects of the details (see table below).
for example, for the indicator "Matching degree with CHS-DRG grouping scheme (core group)," there are only eight cities with more than 90% matching degree and three cities with a matching degree of less than 30%.
zheng jie, an urban group, says this suggests that even though the grouping names are exactly the same as CHS-DRG, their connotations don't match well.
health care department in the commission of information companies to carry out DRG grouping device construction, we must pay attention to this "table different" problem.
: DRG payment reform is an important measure to standardize the behavior of medical services, improve the efficiency of the use of medical insurance funds, and further improve the scientific, refined and information-based management service level of medical insurance.
In accordance with the DRG paid pilot work programme, next year China will enter the substantive payment phase, although this year affected by the epidemic, some pilot cities have been delayed, but overall DRG payment pilot work is still in the expected range of steady progress, will be able to china's medical security cause of the "14th Five-Year Plan" to open a good situation.