htmlOn April 23, the Guangxi Medical Insurance Bureau held an evaluation meeting on the DRGs pilot achievement results in Liuzhou City. Photo by Zhou Xiaonan htmlOn April 23, the Guangxi Medical Insurance Bureau held an evaluation meeting on the DRGs pilot results in Liuzhou City. Photo by Zhou Xiaonan China News Service, Liuzhou, April 23 (Zhou Xiaonan) The reporter learned from the Guangxi DRGs pilot achievement evaluation meeting held here on the 23rd that Liuzhou City uses the reform of medical insurance payment methods as a starting point, explores the reform of compound medical insurance payment methods mainly based on the DRGs disease group point method, implements payment methods such as general outpatient clinics based on head disease type, family bed average point method, and day surgery daily payment methods, focusing on solving the problem of expensive and difficult treatment for the people.
Liuzhou is the first city to achieve the reform goal of "complex medical insurance payment method based on disease types" in the country. In July 2017, Liuzhou City officially implemented a point payment system based on disease diagnosis-related groups (DRGs) under the control of total medical expenses, that is, through the formulation of unified disease diagnosis classification quota payment standards, the utilization of medical resources can be achieved.
At the same time, the DRGs points are associated with all other unified fund payment projects to ensure that the unified fund is paid based on revenue and expenditure. The implementation of general outpatient coordination is to pay for head diseases according to head diseases, outpatient chronic diseases according to head diseases, family beds according to daily average point method, day surgery is paid for beds, and other service items are paid for projects, forming a composite payment method.
At present, Liuzhou City has implemented the payment of 73 designated medical institutions based on the disease diagnosis-related group (DRGs) point method, including more than 600 group points, covering first, second and third-level hospitals, setting a precedent for domestic first-level hospitals to implement medical insurance based on DRGs.
In order to encourage the development of traditional Chinese medicine and improve the efficiency of the use of medical insurance funds, in the process of implementing the DRGs point method payment, Liuzhou City also explored and implemented the "pay by efficacy value". At present, Liuzhou City has launched 10 traditional Chinese medicine diseases, including lumbar conical interdisc herniation, clavicle fractures and mixed hemorrhoids, pay for the efficacy.
After a series of precise measures, the situation of win-win situation between medical care, insurance and patients has begun to emerge. In the past three years, the average cost of designated medical institutions in the city at three levels has remained at around 10,000, far lower than the level of medical institutions at the same level in Guangxi. The city's third-level medical institutions have a significant decline in medical expenses, with the average hospitalization cost falling from 10,014 yuan to 9,800 yuan, and the individual's own-paid average expenses dropped from 2,080.3 yuan to 2,071.57 yuan, and the public's burden of medical treatment has decreased. After the implementation of the precise payment method for outpatient chronic diseases, the phenomenon of waste of medical expenses has been effectively curbed. After the reform, the annual expenditure on outpatient chronic diseases of the city’s employee medical insurance decreased by nearly 120 million yuan each year, and the chronic disease indicators of each designated medical institution have varying degrees of balance.
Tsinghua University Hospital Management Institute and School of Public Administration Yang Yansui Professor Yang pointed out that Liuzhou's DRGs reflect the essence of precision in the medical insurance reform, squeeze out the moisture in medical insurance operations, avoid excessive treatment by doctors, and prescribe large prescription is more in line with the interests of patients and is conducive to the steady development of the medical insurance industry. (End)
