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    Home > Medical News > Latest Medical News > National Medical Insurance Administration, the latest development of medical insurance payment reform

    National Medical Insurance Administration, the latest development of medical insurance payment reform

    • Last Update: 2021-03-22
    • Source: Internet
    • Author: User
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    Medical Network, March 11, the National Medical Insurance Bureau announced the latest progress in the reform of medical insurance payment
     
    Medical insurance payment reform, the latest progress announced
     
    On March 8, the National Medical Insurance Administration issued the "2020 Medical Security Development Statistics Express".
    Regarding the reform of medical insurance payment, the latest developments in the pilot cities were mentioned:
     
    "Continue to promote the reform of payment methods, and carry out DRG-paying national pilot work in 30 cities.
    All 30 pilot cities have passed the evaluation and assessment before the simulation operation and entered the simulation operation stage; in the mid-term, 71 cities were determined to carry out the regional point method total budget and DIP Paid pilot work.
    "
     
    Among them, DRG payment is based on disease diagnosis-related grouping, and DIP payment is based on disease combination points.
     
    As early as May 2019, the National Medical Insurance Administration announced a list of 30 DRG-paying national pilot cities, and then released 376 ADRG groups and 618 DRG sub-groups in October 2019 and June 2020, respectively, to further promote DRG Payment reform.
    Judging from the current progress, all 30 pilot cities have passed the pre-simulation evaluation and entered the simulation operation stage.
    It is expected that all pilot cities will enter the actual payment stage in 2021.
     
     
    On November 4, 2020, the National Medical Insurance Administration website announced the "Notice of the Office of the National Medical Security Administration on Printing and Distributing the List of Pilot Cities for Regional Point Method Total Budget and Dice-based Payment", and 71 cities in 27 provinces (municipalities directly under the Central Government) are included in DIP The paid pilots are:
     
    Tianjin, Shanghai,
     
    Hebei Province: Xingtai City, Tangshan City, Langfang City, Baoding City
     
      Shanxi Province: Yangquan City
     
      Inner Mongolia Autonomous Region: Ordos City, Chifeng City, Hulunbuir City
     
      Liaoning Province: Fushun City Yingkou City
     
      Jilin Province: Liaoyuan City
     
      Heilongjiang Province: Jiamusi City, Yichun City, Hegang City
     
      Jiangsu Province: Huai'an City, Zhenjiang City, Suqian City
     
      Anhui Province: Suzhou City, Huainan City, Wuhu City, Fuyang City, Xuancheng City, Huangshan City
     
      Fujian Province: Xiamen City, Ningde City, Putian City, Longyan City
     
      Jiangxi Province: Ganzhou City, Yichun City, Yingtan City
     
      Shandong Province: Dongying City, Zibo City, Weifang City, Dezhou City, Jining City, Tai'an City, Binzhou City
     
      Henan Province: Jiaozuo City and Shangqiu City
     
      Hubei Province: Yichang City and Jingzhou City
     
      Hunan Province: Changde City, Yiyang City, Shaoyang City
     
      Guangdong Province: Guangzhou City, Heyuan City, Shantou City, Zhuhai City, Shenzhen City
     
      Hainan Province: Sanya City
     
      Sichuan Province: Luzhou City, Deyang City, Nanchong City
     
      Guizhou Province: Zunyi City, Bijie City, Qiannan Autonomous Prefecture
     
      Yunnan Province: Wenshan Prefecture Zhaotong City
     
      Tibet Autonomous Region: Lhasa City Xigaze City
     
      Shaanxi Province: Hancheng
     
      Gansu Province: Dingxi City, Wuwei City, Longnan City
     
      Qinghai Province: Haidong City
     
      Ningxia Hui Autonomous Region: Shizuishan City, Guyuan City
     
      Xinjiang Uygur Autonomous Region: Aksu Region Hami City
     
      The above list is determined based on the voluntary declarations made by the provincial (regional, municipal) medical insurance bureaus.
    The National Medical Insurance Bureau requires the relevant provincial medical insurance bureaus to strengthen guidance, supervise and urge the pilot city medical insurance bureaus to strengthen organization and leadership, clarify the division of responsibilities, and fully implement the pilot tasks And requirements to ensure tangible results.
    By the end of 2021, all pilot areas will enter the actual payment stage.
     
      It is believed that with the advancement of medical insurance payment reform, DIP payment will also make substantial progress this year.
     
      Hospitals and pharmaceutical companies face challenges
     
      DRG (Diagnosis Related Groups), that is, disease diagnosis related groups.
    In the 1970s, as medical expenses continued to rise, it put greater pressure on medical insurance units.
    DRG was first introduced by the United States as a means of payment management.
    Afterwards, many developed countries’ medical regulatory agencies began exploring and researching on medical cost control, implementing fixed payments for diseases and related complications, and reimbursing payments in proportion to the total cost of the disease.
    It is replaced by DRG payment, which encourages hospitals to reduce medical costs and shorten the length of hospital stay on the basis of ensuring medical quality.
     
      DIP (Big Data Diagnosis-Intervention Packet), that is, diseases based on big data.
    Use the complete management system established by the advantages of big data, explore the common characteristics of "disease diagnosis + treatment" to objectively classify medical record data, and form a standardized combination of each disease and treatment method in the full sample case data in a certain area Positioning, which objectively reflects the severity of the disease, the complex state of treatment, the level of resource consumption, and the norms of clinical behavior.
    It can be applied to medical insurance payment, fund supervision, hospital management and other fields.
     
      Whether it is DRG or DIP, the reform of the medical insurance payment system is undoubtedly a profound revolution and reform, which has an impact on the behavior and thinking of the government, medical insurance, hospitals, and patients.
    Especially for hospitals, the "game" between medical insurance and hospitals will last forever.
     
      Under the supervision and guidance of the National Medical Insurance Administration at an extraordinary speed, DRG and DIP payments have become the general trend, requiring public hospitals to transform from scale expansion to connotation construction, and from extensive operation to intensive operation.
    Through DRG and DIP, hospitals can realize cross-regional, cross-hospital and cross-specialty management.
     
      A pharmacy expert told Cyberlan that DRG payment and DIP payment will be more strict and effective cost control methods than policies such as controlling the proportion of drugs and restricting auxiliary drugs.
    For example, under DRG payment, medical staff will try their best to adopt the most reasonable and economical treatment plan.
    If the actual cost of treatment exceeds the provisions of the relevant documents, it needs to be absorbed by the hospital itself; if a part of the cost can be saved by improving the management and diagnosis and treatment process, it will be included in the hospital's profit.
     
      It is also very important for pharmaceutical companies to understand DRG and DIP.
    For example, in the usual department promotion meetings, pharmaceutical companies should know how to capture the attention of customers.
    Representatives of traditional medicine only introduce the information on how to use our products.
    The future medical promoters must understand the relevant terms of DRG, learn to interact with doctors, combine the evaluation indicators of DRGs, and embed the information they want to convey.
    It can be seen that it is very important for pharmaceutical companies to ensure that the company 's products enter the standard treatment procedures for disease group treatment .
      Medical Network, March 11, the National Medical Insurance Bureau announced the latest progress in the reform of medical insurance payment
     
      Medical insurance payment reform, the latest progress announced
     
      On March 8, the National Medical Insurance Administration issued the "2020 Medical Security Development Statistics Express".
    Regarding the reform of medical insurance payment, the latest developments in the pilot cities were mentioned:
     
       "Continue to promote the reform of payment methods, and carry out DRG-paying national pilot work in 30 cities.
    All 30 pilot cities have passed the evaluation and assessment before the simulation operation and entered the simulation operation stage; in the mid-term, 71 cities were determined to carry out the regional point method total budget and DIP Paid pilot work.
    "
     
      Among them, DRG payment is based on disease diagnosis-related grouping, and DIP payment is based on disease combination points.
     
      As early as May 2019, the National Medical Insurance Administration announced a list of 30 DRG-paying national pilot cities, and then released 376 ADRG groups and 618 DRG sub-groups in October 2019 and June 2020, respectively, to further promote DRG Payment reform.
    Judging from the current progress, all 30 pilot cities have passed the pre-simulation evaluation and entered the simulation operation stage.
    It is expected that all pilot cities will enter the actual payment stage in 2021.
     
     
      On November 4, 2020, the National Medical Insurance Administration website announced the "Notice of the Office of the National Medical Security Administration on Printing and Distributing the List of Pilot Cities for Regional Point Method Total Budget and Dice-based Payment", and 71 cities in 27 provinces (municipalities directly under the Central Government) are included in DIP The paid pilots are:
     
      Tianjin, Shanghai,
     
      Hebei Province: Xingtai City, Tangshan City, Langfang City, Baoding City
     
      Shanxi Province: Yangquan City
     
      Inner Mongolia Autonomous Region: Ordos City, Chifeng City, Hulunbuir City
     
      Liaoning Province: Fushun City Yingkou City
     
      Jilin Province: Liaoyuan City
     
      Heilongjiang Province: Jiamusi City, Yichun City, Hegang City
     
      Jiangsu Province: Huai'an City, Zhenjiang City, Suqian City
     
      Anhui Province: Suzhou City, Huainan City, Wuhu City, Fuyang City, Xuancheng City, Huangshan City
     
      Fujian Province: Xiamen City, Ningde City, Putian City, Longyan City
     
      Jiangxi Province: Ganzhou City, Yichun City, Yingtan City
     
      Shandong Province: Dongying City, Zibo City, Weifang City, Dezhou City, Jining City, Tai'an City, Binzhou City
     
      Henan Province: Jiaozuo City and Shangqiu City
     
      Hubei Province: Yichang City and Jingzhou City
     
      Hunan Province: Changde City, Yiyang City, Shaoyang City
     
      Guangdong Province: Guangzhou City, Heyuan City, Shantou City, Zhuhai City, Shenzhen City
     
      Hainan Province: Sanya City
     
      Sichuan Province: Luzhou City, Deyang City, Nanchong City
     
      Guizhou Province: Zunyi City, Bijie City, Qiannan Autonomous Prefecture
     
      Yunnan Province: Wenshan Prefecture Zhaotong City
     
      Tibet Autonomous Region: Lhasa City Xigaze City
     
      Shaanxi Province: Hancheng
     
      Gansu Province: Dingxi City, Wuwei City, Longnan City
     
      Qinghai Province: Haidong City
     
      Ningxia Hui Autonomous Region: Shizuishan City, Guyuan City
     
      Xinjiang Uygur Autonomous Region: Aksu Region Hami City
     
      The above list is determined based on the voluntary declarations made by the provincial (regional, municipal) medical insurance bureaus.
    The National Medical Insurance Bureau requires the relevant provincial medical insurance bureaus to strengthen guidance, supervise and urge the pilot city medical insurance bureaus to strengthen organization and leadership, clarify the division of responsibilities, and fully implement the pilot tasks And requirements to ensure tangible results.
    By the end of 2021, all pilot areas will enter the actual payment stage.
     
      It is believed that with the advancement of medical insurance payment reform, DIP payment will also make substantial progress this year.
     
      Hospitals and pharmaceutical companies face challenges
     
      DRG (Diagnosis Related Groups), that is, disease diagnosis related groups.
    In the 1970s, as medical expenses continued to rise, it put greater pressure on medical insurance units.
    DRG was first introduced by the United States as a means of payment management.
    Afterwards, many developed countries’ medical regulatory agencies began exploring and researching on medical cost control, implementing fixed payments for diseases and related complications, and reimbursing payments in proportion to the total cost of the disease.
    It is replaced by DRG payment, which encourages hospitals to reduce medical costs and shorten the length of hospital stay on the basis of ensuring medical quality.
     
      DIP (Big Data Diagnosis-Intervention Packet), that is, diseases based on big data.
    Use the complete management system established by the advantages of big data, explore the common characteristics of "disease diagnosis + treatment" to objectively classify medical record data, and form a standardized combination of each disease and treatment method in the full sample case data in a certain area Positioning, which objectively reflects the severity of the disease, the complex state of treatment, the level of resource consumption, and the norms of clinical behavior.
    It can be applied to medical insurance payment, fund supervision, hospital management and other fields.
     
      Whether it is DRG or DIP, the reform of the medical insurance payment system is undoubtedly a profound revolution and reform, which has an impact on the behavior and thinking of the government, medical insurance, hospitals, and patients.
    Especially for hospitals, the "game" between medical insurance and hospitals will last forever.
     
      Under the supervision and guidance of the National Medical Insurance Administration at an extraordinary speed, DRG and DIP payments have become the general trend, requiring public hospitals to transform from scale expansion to connotation construction, and from extensive operation to intensive operation.
    Through DRG and DIP, hospitals can realize cross-regional, cross-hospital and cross-specialty management.
     
      A pharmacy expert told Cyberlan that DRG payment and DIP payment will be more strict and effective cost control methods than policies such as controlling the proportion of drugs and restricting auxiliary drugs.
    For example, under DRG payment, medical staff will try their best to adopt the most reasonable and economical treatment plan.
    If the actual cost of treatment exceeds the provisions of the relevant documents, it needs to be absorbed by the hospital itself; if a part of the cost can be saved by improving the management and diagnosis and treatment process, it will be included in the hospital's profit.
     
      It is also very important for pharmaceutical companies to understand DRG and DIP.
    For example, in the usual department promotion meetings, pharmaceutical companies should know how to capture the attention of customers.
    Representatives of traditional medicine only introduce the information on how to use our products.
    The future medical promoters must understand the relevant terms of DRG, learn to interact with doctors, combine the evaluation indicators of DRGs, and embed the information they want to convey.
    It can be seen that it is very important for pharmaceutical companies to ensure that the company 's products enter the standard treatment procedures for disease group treatment .
      Medical Network, March 11, the National Medical Insurance Bureau announced the latest progress in the reform of medical insurance payment
     
      Medical insurance payment reform, the latest progress announced
      Medical insurance payment reform, the latest progress announced
     
      On March 8, the National Medical Insurance Administration issued the "2020 Medical Security Development Statistics Express".
    Regarding the reform of medical insurance payment, the latest developments in the pilot cities were mentioned:
     
       "Continue to promote the reform of payment methods, and carry out DRG-paying national pilot work in 30 cities.
    All 30 pilot cities have passed the evaluation and assessment before the simulation operation and entered the simulation operation stage; in the mid-term, 71 cities were determined to carry out the regional point method total budget and DIP Paid pilot work.
    "
     
      Among them, DRG payment is based on disease diagnosis-related grouping, and DIP payment is based on disease combination points.
    Disease disease disease
     
      As early as May 2019, the National Medical Insurance Administration announced a list of 30 DRG-paying national pilot cities, and then released 376 ADRG groups and 618 DRG sub-groups in October 2019 and June 2020, respectively, to further promote DRG Payment reform.
    Judging from the current progress, all 30 pilot cities have passed the pre-simulation evaluation and entered the simulation operation stage.
    It is expected that all pilot cities will enter the actual payment stage in 2021.
     
     
      On November 4, 2020, the National Medical Insurance Administration website announced the "Notice of the Office of the National Medical Security Administration on Printing and Distributing the List of Pilot Cities for Regional Point Method Total Budget and Dice-based Payment", and 71 cities in 27 provinces (municipalities directly under the Central Government) are included in DIP The paid pilots are:
     
      Tianjin, Shanghai,
     
     
      Hebei Province: Xingtai City, Tangshan City, Langfang City, Baoding City
     
      Shanxi Province: Yangquan City
     
      Inner Mongolia Autonomous Region: Ordos City, Chifeng City, Hulunbuir City
     
      Liaoning Province: Fushun City Yingkou City
     
      Jilin Province: Liaoyuan City
     
      Heilongjiang Province: Jiamusi City, Yichun City, Hegang City
     
      Jiangsu Province: Huai'an City, Zhenjiang City, Suqian City
     
      Anhui Province: Suzhou City, Huainan City, Wuhu City, Fuyang City, Xuancheng City, Huangshan City
     
      Fujian Province: Xiamen City, Ningde City, Putian City, Longyan City
     
      Jiangxi Province: Ganzhou City, Yichun City, Yingtan City
     
      Shandong Province: Dongying City, Zibo City, Weifang City, Dezhou City, Jining City, Tai'an City, Binzhou City
     
      Henan Province: Jiaozuo City and Shangqiu City
     
      Hubei Province: Yichang City and Jingzhou City
     
      Hunan Province: Changde City, Yiyang City, Shaoyang City
     
      Guangdong Province: Guangzhou City, Heyuan City, Shantou City, Zhuhai City, Shenzhen City
     
      Hainan Province: Sanya City
     
      Sichuan Province: Luzhou City, Deyang City, Nanchong City
     
      Guizhou Province: Zunyi City, Bijie City, Qiannan Autonomous Prefecture
     
      Yunnan Province: Wenshan Prefecture Zhaotong City
     
      Tibet Autonomous Region: Lhasa City Xigaze City
     
      Shaanxi Province: Hancheng
     
      Gansu Province: Dingxi City, Wuwei City, Longnan City
     
      Qinghai Province: Haidong City
     
      Ningxia Hui Autonomous Region: Shizuishan City, Guyuan City
     
      Xinjiang Uygur Autonomous Region: Aksu Region Hami City
     
      The above list is determined based on the voluntary declarations made by the provincial (regional, municipal) medical insurance bureaus.
    The National Medical Insurance Bureau requires the relevant provincial medical insurance bureaus to strengthen guidance, supervise and urge the pilot city medical insurance bureaus to strengthen organization and leadership, clarify the division of responsibilities, and fully implement the pilot tasks And requirements to ensure tangible results.
    By the end of 2021, all pilot areas will enter the actual payment stage.
     
      It is believed that with the advancement of medical insurance payment reform, DIP payment will also make substantial progress this year.
     
      Hospitals and pharmaceutical companies face challenges
      Hospital Hospital hospitals, pharmaceutical companies and meet challenges
     
      DRG (Diagnosis Related Groups), that is, disease diagnosis related groups.
    In the 1970s, as medical expenses continued to rise, it put greater pressure on medical insurance units.
    DRG was first introduced by the United States as a means of payment management.
    Afterwards, many developed countries’ medical regulatory agencies began exploring and researching on medical cost control, implementing fixed payments for diseases and related complications, and reimbursing payments in proportion to the total cost of the disease.
    It is replaced by DRG payment, which encourages hospitals to reduce medical costs and shorten the length of hospital stay on the basis of ensuring medical quality.
     
      DIP (Big Data Diagnosis-Intervention Packet), that is, diseases based on big data.
    Use the complete management system established by the advantages of big data, explore the common characteristics of "disease diagnosis + treatment" to objectively classify medical record data, and form a standardized combination of each disease and treatment method in the full sample case data in a certain area Positioning, which objectively reflects the severity of the disease, the complex state of treatment, the level of resource consumption, and the norms of clinical behavior.
    It can be applied to medical insurance payment, fund supervision, hospital management and other fields.
     
      Whether it is DRG or DIP, the reform of the medical insurance payment system is undoubtedly a profound revolution and reform, which has an impact on the behavior and thinking of the government, medical insurance, hospitals, and patients.
    Especially for hospitals, the "game" between medical insurance and hospitals will last forever.
     
      Under the supervision and guidance of the National Medical Insurance Administration at an extraordinary speed, DRG and DIP payments have become the general trend, requiring public hospitals to transform from scale expansion to connotation construction, and from extensive operation to intensive operation.
    Through DRG and DIP, hospitals can realize cross-regional, cross-hospital and cross-specialty management.
     
      A pharmacy expert told Cyberlan that DRG payment and DIP payment will be more strict and effective cost control methods than policies such as controlling the proportion of drugs and restricting auxiliary drugs.
    For example, under DRG payment, medical staff will try their best to adopt the most reasonable and economical treatment plan.
    If the actual cost of treatment exceeds the provisions of the relevant documents, it needs to be absorbed by the hospital itself; if a part of the cost can be saved by improving the management and diagnosis and treatment process, it will be included in the hospital's profit.
     
      It is also very important for pharmaceutical companies to understand DRG and DIP.
    For example, in the usual department promotion meetings, pharmaceutical companies should know how to capture the attention of customers.
    Representatives of traditional medicine only introduce the information on how to use our products.
    The future medical promoters must understand the relevant terms of DRG, learn to interact with doctors, combine the evaluation indicators of DRGs, and embed the information they want to convey.
    It can be seen that it is very important for pharmaceutical companies to ensure that the company 's products enter the standard treatment procedures for disease group treatment .
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