Under the payment method of DRG, each case will enter different diagnosis related groups according to different diagnosis, different treatment methods and different patient characteristics. On this basis, the insurance institution will no longer pay the medical institution according to the actual cost of the patient in the hospital (that is, according to the service items), but according to the payment standard of the diagnosis-related group where the case entered.
Application of DRG payment and DIP payment in medical insurance;
1, DRG is paid by groups related to disease diagnosis, and DIP is paid by disease score, both of which are medical insurance payment systems;
2. The foothold of paid design is different. DRG payment pays attention to the combination of cases, which reflects the guiding role of medical institutions in standardizing the diagnosis and treatment path of "the same disease and the same operation"; DIP uses big data to analyze and guide the behaviors of different regions, different periods and different medical institutions. Taking the disease combination as a unit, according to the functional orientation of medical institutions at all levels, DIP gives different scores to different diseases, reflecting the guiding role of treatment methods;
3. Different grouping principles. DRG is grouped from coarse to fine, emphasizing on the basis of clinical experience; DIP is grouped from fine to coarse, emphasizing the statistical analysis of clinical objective and real data;
4. The difference between the rate and the integral value. The calculation of DRG payment standard is divided into the calculation of relative weight and rate; The calculation of DIP payment standard is divided into the calculation of disease score and score;
5. There are differences in supervision difficulty.
To sum up, DRG is mainly a payment method of medical insurance to hospitals, which is to divide related diseases into a group and pay medical institutions in packages, instead of paying them one by one as in the past. After using DRG payment method, there is a fixed price and packaged payment, which promotes the hospital to try its best to control the expenses, effectively control the unreasonable increase of medical expenses and reduce the economic burden of patients on the premise of ensuring the quality of medical services.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.