Zhejiang medical service prices: 4 situations trigger adjustments, 4 situations cannot be increased!

Zhejiang will initiate a dynamic adjustment of medical service prices, four of which are adjustable, and four of them cannot be increased

On August 17, Zhejiang Province issued a notice on publicly soliciting opinions and suggestions on the "Implementation Opinions on Establishing a Dynamic Price Adjustment Mechanism for Medical Services (Draft for Solicitation of Opinions)"

The draft opinion proposes that Zhejiang province and its districts and cities will carry out the dynamic adjustment of medical service prices in accordance with the basic path of “ setting start conditions, evaluation triggering implementation, adjustment of ups and downs, convergence of medical insurance payments, and tracking, monitoring and evaluation ”

Setting start conditions, evaluation triggering implementation, adjustment of ups and downs, connection of medical insurance payment, follow-up monitoring and assessment

Trigger criteria

Trigger criteria

Last year, we made room for centralized procurement of medicines or medical consumables

The adoption of standardized diagnosis and treatment behaviors last year led to a significant decrease in the proportion of revenue from drugs, medical consumables, inspections, and inspections

Due to the price of medical services, the charges for DRG patients were generally high or low last year

Constraint standards

Constraint standards

The average cost of outpatient or hospitalization in the region increased by more than 5% last year

In accordance with the principle of accrual, the expenditure of the regional employee basic medical insurance coordinating fund or the basic medical insurance fund of urban and rural residents increased by more than 10% in the previous year or there was an annual deficit in revenue and expenditure

It is not appropriate to adjust the price of medical services when major disasters or major public health incidents occurred in the region that year

Evaluation and implementation, dynamic adjustment

Evaluation and implementation, dynamic adjustment

The medical insurance department (or entrusting a third-party organization) conducts a quantitative assessment of relevant indicators in the region every year.

Reasonable calculation space

Reasonable calculation space

The space is mainly determined by the method of "historical base" plus "reasonable growth".

Take the total amount of medical expenses before each dynamic adjustment as the base, and comprehensively determine the reasonable adjustment of medical service price space based on the effect of cost control, economic development, and the price reduction of centralized procurement of medicines or medical consumables.

Optimize selection items
.
Priority will be given to price adjustments related to medical consumables with significant declines in centralized procurement, as well as medical service price items that have a relatively significant decline in the proportion of revenue from medicines, medical consumables, inspections, and inspections
.

Optimize selection items
.
Priority will be given to price adjustments related to medical consumables with significant declines in centralized procurement, as well as medical service price items that have a relatively significant decline in the proportion of revenue from medicines, medical consumables, inspections, and inspections
.

According to the established space and the service volume of the previous year, the medical institution puts forward suggestions for improving projects and adding new projects, and submits relevant project cost estimates
.
Among them, the improvement projects were proposed by 13 provincial-level public hospitals in Hangzhou and public medical institutions at all levels in their jurisdictions led by the medical insurance departments of districts and cities; the new projects were mainly proposed by national and regional medical centers and leading medical institutions for key disciplines
.

The medical insurance department optimizes the selection of projects, pays attention to the functional positioning, service capabilities and operational characteristics of different types and levels of medical institutions, takes into account specialist medical institutions with special income structures and primary medical and health institutions, supports the development of weak subjects such as pediatrics, and supports the inheritance and innovative development of traditional Chinese medicine
.

Specifically, it should meet the following requirements:

The first is to give priority to the DRG disease group, which has a high proportion of technical labor services, serious deviations in costs and prices, medical technology innovation and development, medical device replacement, and significantly reduced average fees, such as DRG disease group and other related medical service price items that are included in the scope of improvement;

The second is to give priority to the "Medical Peak" construction of the National Medical Center, the construction of the National Regional Medical Center, the construction of key disciplines, and the medical service price items required for the high-quality development of Chinese medicine into the new scope;

The third is to give priority to the price adjustment of medical consumables related to medical consumables that have a significant decline in centralized purchases , and medical service price items that have a relatively significant decline in the proportion of drugs, medical consumables, inspections, and inspections .

Priority to include medical consumables related to centralized procurement of significant declines in the scope of price adjustment

Make scientific plans
.
Gradually unify the prices of medical services within the jurisdiction, and establish relatively reasonable price comparisons among different levels of medical institutions such as provinces, cities, and counties

Make scientific plans
.
Gradually unify the prices of medical services within the jurisdiction, and establish relatively reasonable price comparisons among different levels of medical institutions such as provinces, cities, and counties

The medical insurance departments at the provincial level and in the districts and cities shall take the lead in researching and formulating plans, and allocate space to improved projects and new projects in a reasonable manner
.
The plans for districts and cities mainly involve improving the price adjustments in the project.
It is necessary to balance the relationship between the project, structure and range, gradually unify the price of medical services within the jurisdiction, and establish relatively reasonable medical institutions at different levels of provinces, cities, and counties.
The price comparison relationship, in principle, the municipal price of the same level of medical institutions shall not be higher than the provincial level, and the plan must be reported to the Provincial Medical Insurance Bureau for filing and implementation
.

Specifically, it should meet the following requirements:

First, it is expected that the increase in revenue will not exceed the established space, and the space required for new projects should be fully reserved, and attention should be paid to the balance between medical institutions and disciplines;

The second is to focus on increasing the price of medical services that reflect the value of technical labor services, and reducing the price of inspections and large-scale equipment that account for a high proportion of equipment and material consumption;

The third is to reasonably determine the price gap between different levels of medical institutions by comprehensively considering factors such as the level and function positioning of medical institutions, the level of physicians, market demand, and the direction of resource allocation within the region; the fourth is to strengthen communication and coordination between regions, similar economic development levels, and medical development In areas with similar levels and adjacent geographical locations, the price levels should maintain a reasonable level of convergence
.

Optimize adjustment procedures
.
Trial prices are implemented for newly added projects, and the trial period generally does not exceed 2 years

Optimize adjustment procedures
.
Trial prices are implemented for newly added projects, and the trial period generally does not exceed 2 years

Optimize and improve the price setting and adjustment procedures of medical services in accordance with laws and regulations, and conduct price cost investigations and expert demonstrations through government purchases of services
.
Strengthen risk assessment, focus on researching and judging price adjustment projects that have a wide range of influence or involving groups with special difficulties, and prevent personality problems from expanding into systemic risks
.

Trial prices are implemented for newly added projects, and the trial period generally does not exceed 2 years
.
During the trial period, the medical insurance department (or entrust a third-party agency) to conduct follow-up evaluation
.
After the trial period expires, the official price will be announced based on the evaluation of the service effect and cost and income
.

Trial prices are implemented for newly added projects, and the trial period generally does not exceed 2 years