As one of the major medical reforms, the medical insurance control fee began to start the "first shot" of the medical reform in 2018. Recently, Guangxi, Zhejiang, Sichuan, Henan and other provinces have intensively issued notices to expand the scope of payment by disease. According to the incomplete statistics of the reporter, nearly two-thirds of the provinces in the country have implemented or are piloting the implementation of sickness-based fees. According to industry insiders, this change means that China's medical reform is taking a substantial step.
According to the type of disease, the patient is admitted to the hospital, and undergoes standardized treatment according to the treatment management process of the disease. After the clinical efficacy standard is reached, the patient is discharged from the hospital. The expenses for diagnosis, treatment, surgery, etc. are all packaged at one time. The hospital charges according to this standard, and the medical insurance fund and the insured patients pay according to the prescribed proportion.
Since 2017, the policy of supporting payment by disease has been continuously introduced. At the beginning of 2017, the National Development and Reform Commission, the Health Planning Commission, and the Ministry of Human Resources and Social Security jointly issued the "Notice on Promoting the Work of Charges by Diseases." In mid-2017, the General Office of the State Council issued the “Guiding Opinions on Further Deepening the Reform of Basic Medical Insurance Payment Methodsâ€, requiring that from 2017 onwards, the multi-component medical insurance payment method based on disease-based payment will be fully implemented. At the end of 2017, several provinces such as Anhui and Shanxi successively introduced policies, and the scope of trials for disease-based payment was significantly accelerated. In 2018, the speed of advancement in various provinces was greatly accelerated.
Judging from the current implementation of the provinces, the “packaged†package for medical treatment has covered more than 100 diseases, and most of them are common diseases. "It is beneficial to patients according to the type of disease, which can reduce the burden of patients' medical treatment. At the same time, the treatment costs can be predicted in advance." Shandong has tried to charge a public hospital doctor according to the disease to the "Economic Information Daily" reporter, with acute simplicity. For example, appendicitis, before the treatment of Jinan public top three hospitals, the cost of more than 12,000 yuan floating, and the case-based charges fell to 10,000 yuan.
Gu Xuefei, deputy researcher of the Health Development Research Center of the National Health and Family Planning Commission, believes that the medical insurance management department implements a variety of comprehensive payment methods such as bed-by-day, disease-based, and total prepayment through reform payment methods. The principle is “balance retention, over-expenditure and reasonable sharingâ€. The purpose is to improve the efficiency of fund use, and hope that the hospital will actively control the fees while ensuring the quality of medical care, and achieve sustainable development of medical insurance.
Zhu Hengpeng, director of the Public Policy Center of the Chinese Academy of Social Sciences, believes that the current problem is that it is difficult to make substantial progress in raising the cost of medical services and reducing the cost of medicines: it is impossible to effectively reduce the hospital’s price before the price of medical services has increased. Drug costs and inspection fees, otherwise the hospital will not survive. However, before the hospital's drug costs did not fall, the government departments did not dare to raise the price of medical services, fearing that medical expenses would rise further.
As the depth of the aging society approaches, the collection of fewer branches will become the new normal of the medical insurance fund. In fact, at present, for the medical insurance department, the open source space is not large, and cost control has become a necessary path for medical reform.
Zhu Hengpeng said that under the conditions of universal health insurance, a considerable proportion of medical expenses are paid by medical insurance institutions. In order to avoid excessive medical treatment between doctors and patients, it is necessary to avoid payment methods according to service items as much as possible, and adopt a series of other Scientific payment model. Pilots in some parts of the country have also achieved remarkable results. For example, urban and rural residents' medical insurance and urban workers' medical insurance clinics can try to adopt the system of pay-per-person payment. Hospitalization payment can adopt a combination of total prepayment and case-based payment. These systems can effectively alleviate over-medication and over-examination.
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