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| In the future, China's medical insurance payment reform will present four trends. |
First, budget management has become the basic premise for the reform of payment methods.
Strengthening budget management and total amount control is a basic experience of medical insurance payment. Medical insurance should always pursue quality assurance for the insured, and fund balance for the sustainable development of the system. Therefore, the medical insurance fund must establish a budget management mechanism, and expenditure must be controlled by the total amount. If there is no total amount control mechanism, even the implementation of DRGs will not escape the surge in hospitalization rates and cost overruns.
There are various payment methods under the total amount control budget management. Most regions choose the "direct division method", that is, the total budget is divided into each medical institution based on the previous three years. The direct division method is simple and intuitive, and easy to implement, but there are problems such as simple and rude and insufficient supervision in practical operations. Combined with DRGs or the "points method", etc., the implementation of general control in the fund coordination area has become the direction, and the regional medical consortium package payment has become a supplementary path.
Secondly, multiple and compound payment methods have become a feasible path.
The core of the reform of the medical insurance payment method is to focus on promoting the reform of the multiple and compound medical insurance payment methods, which are mainly based on the type of payment. According to the diversity of medical services and the policy support environment, it is the best choice to innovate and adopt multiple payment methods. For example, pay per capita for grass-roots institutions. For special and difficult diseases, pay by project. The disease can be paid on a case-by-case basis.
Paying by disease type not only includes a single disease payment model, but also includes day surgery, outpatient chronic disease, outpatient major disease, and DRGs. At present, it is difficult to implement the payment of single diseases. On the one hand, the standard design is unreasonable, which is not conducive to tiered diagnosis and treatment and encourages the application of medical institutions; on the other hand, the expansion of profitable operating models of public medical institutions has become an obstacle to promotion.
Third, the negotiation and purchase of drugs for national health insurance became the norm.
In 2018, special anti-cancer drug medical insurance access negotiations negotiated an average price reduction of 17% for 17 anticancer drugs, and “4 + 7” cities brought an average price reduction of 25% for 25 drugs. This "bring your own drink" type of medical insurance purchase and payment attempt has achieved the "quality assurance" and "fund balance" functions of medical insurance payments.
In 2019, the state intends to summarize experiences and formulate and improve new policy documents for the procurement of concentrated supplies of pharmaceutical consumables. The “consumption ratio” of public hospitals is constantly rising, and the state and local governments have been paying close attention to it. It can be predicted that it is only a matter of time before negotiations on high-value consumables for medical insurance or volume procurement are organized.
Fourth, the regional master control combined with the point method was tried out.
The "point method" fully integrates the total budget with other payment methods, and can realize payment by disease based on regional budget management, thereby encouraging hospitals to provide services and control costs according to patient needs, and can achieve medical insurance control. Cost goals, while taking into account the development of medical technology and the reflection of service value.
From: iPhone client