The State Council has called for deeper reform of the payment method for health insurance.

AuthorRecently, the General Office of the State Council issued the "Guidance on Promoting the Reform of the Regulatory System of the Medical Security Fund" and proposed to deepen the reform of the payment method of medical insurance and strengthen the incentive and restraint effect of medical insurance on medical care and medicinespecific, the guidance mentions: "To improve the monitoring mechanism of medical insurance on medical service behavior, extend the supervision target from medical institutions to medical personnel, and shift the focus of supervision from medical expenses control to medical expenses and medical service performance control."the introduction and implementation of medical and health industry standards for diagnosis and treatment, and gradually carry out clinical path management", "accelerate the comprehensive reform of public hospitals, establish and improve the modern hospital management system, regulate the conduct of diagnosis and treatment."regulate the promotion of appropriate medical technologies around common and health problemsconstantly improve the market-led drug, medical supplies price formation mechanism, improve the medical insurance payment and tender procurement price linkage mechanism." In addition to flight inspection, combatfraud, intelligent monitoring and credit management,, the reform of medical insurance payment methods, the reform of medical service system, the development of clinical path management and other means are also an important means to force hospitals to improve service quality and strengthen the control of medical expensespay-per-disease continues to advance as early as 2017, the General Office of the State Council issued guidance on the reform of the way health care payment is paidthe establishment of the National Health Insurance Administration, began to officially launch the DRG pay ingon national pilot, identified 30 cities as drG pay ingon sing-it-for-all pilot cities, the formation of CHS-DRG sub-groups and paid technical specifications and sub-groups programsOn June 17,, the State Administration of Health Insurance, the Ministry of Finance and the State Administration of Taxation issued the Notice on Doing a Good Job in Basic Medical Security for Urban and Rural Residents in 2020, requiring that medical insurance payments play an important role in regulating medical service behavior and improving the efficiency of the use of medical insurance fundswidely implement multi-complex payment methods based on disease payment, and carry out pilot work in 30 cities related to disease diagnosis subgrouping (DRG) paying countries, according to the Notice on the Issue of the List of National Pilot Cities Paid by Disease Diagnosis-Related Group, the following 30 cities are pilot cities: "Beijing, Tianjin, Hebei Province, Linyi City, Shanxi Province, Wuhai City, Liaoning Province, Shenyang, Jilin Province, Harbin City, Heilongjiang Province, Shanghai, Wuxi, Jiangsu Province, Jinhua City, Anhui Province, Hefei City, Anhui Province, Nanping City, Fujian Province, Shangrao City, Shandong Province, Qingdao City, Anyang City, Hubei Province, Xiangtan City, Foshan City, Guangxi Zhuang Autonomous Region, Zhangzhou City, Zhangzhou City, Zhangzhou City, Chongqing City, Sichuan Province, Panzhihua City, Guizhou Province, Kunming City, Xi'an City, Shaanxi Province, Qingyang City, Qinghai ProvinceXinjiang Uygur Autonomous Region and Xinjiang Production and Construction Corps have designated Urumqi as a pilot city."also on June 17, the National Health Insurance Administration issued the "Health Care Disease Diagnosis Related Sub-Group (CHS-DRG) sub-group program (version 1.0) notice."it is understood that the CHS-DRG sub-group is a further refinement of the 376 core DRG (ADRG) group of the National Health Care DRG (CHS-DRG) Subgroup Scheme, and is the basic unit of DRG payment, with a total of 618 groupsas DRG pay units are refined, the pace of reform of medicating payment methods for disease-based payments will accelerate the "three-step" step of the DRG Paycountry Pilot: 2019 is the top-level design phase of DRG, 2020 is the simulation run phase, and 2021 is the actual pay-as-you-go phase three years, the progress of the DRG pilot work will be arranged as follows: in December 2019, the national sub-groups will be improved, the pilot cities will be prepared and gradually carried out simulation operation; In December 20, the simulation operation was reviewed and the next steps deployed, a typical exchange of experience meetings was held in January-May 2021, supervision and research were conducted by the end of June 2021 to promote the implementation of the work, a special assessment of the pilot work was initiated by the end of September 2021, and a special assessment of the pilot work was initiated, with improved comments and plans for the next steps, and the pilot work and next steps were reported to the State Council by December 2021 multi-complex medical insurance payment pattern to form the requirements of the National Health Insurance Administration, the pilot cities should be august 31 to the DRG paying national pilot technical guidance group to submit assessment reports, after review and approval before the simulation of the operation phase of the work continuously optimize the rules of DRG payment during the simulation run phase, will be the actual implementation of the pay-per-disease next year, to promote the landing of DRG to lay a good foundation in the foreword to the National Medical Administration Disease Diagnosis Subdivision (CHS-DRG) Subdivision Program (version 1.0), the National Health Insurance Administration mentioned that with the advent of China's aging era, the short-term balance of health insurance and long-term balance of payment is difficult to maintain, the introduction of DRG this management tool, the beginning of THE REFORM of the DRG payment method, replacing the current use of pay-per-item, can make medical, health care, patients three parties to reach consensus, the maximum interests to achieve patient-centered, improve the efficiency of the use of medical insurance funds, so that medical insurance management departments and medical institutions to achieve medical insurance purchase negotiations, financial balance, mobilize the enthusiasm of medical personnel, optimize clinical path, standardize the behavior of diagnosis and treatment, improve service efficiency, promote the sustainable development of medical and health services at present, there are data, from the total amount of funds, the traditional pay-per-project mode or the mainstream of China's payment method, reached about 70%, in the future, in the policy of continuous promotion, China will gradually form a multi-composite pattern of medical insurance payment - as soon as possible to achieve the hospital medical services to achieve DRG payment or big data-based by the value of the whole coverage of the sub-species pay son-in-patient medical services, such as mental illness, rehabilitation, etc., that are not suitable for paying for DRG or disease distribution full-scale pay-per-head for people who sign up for family-contracted services With the formation of the pattern of multi-medical insurance payment methods, will really make the hospital fee control behavior from passive to active, will also force large prescriptions, unreasonable drug use phenomenon reduction, while lack of clinical value and rely on marketing-driven drugs will also lose the hospital market original title: The State Council announced: Deepening Health Care Reform.