(a) the implementation of multiple compound medical insurance payment. According to the characteristics of different medical services, we will promote the classification reform of medical insurance payment methods. For in-patient medical services, they are mainly paid according to diseases and related groups of disease diagnosis, and long-term and chronic in-patient medical services can be paid according to bed days; For primary medical services, you can pay per head, and actively explore the combination of per head payment and chronic disease management; For complex cases and outpatient expenses that are not suitable for package payment, they can be paid according to the project. Explore payment methods that meet the characteristics of Chinese medicine services and encourage the provision and use of appropriate Chinese medicine services.

(2) Pay attention to diseases. In principle, the treatment plan and admission standards are relatively clear, and the treatment technology is relatively mature. Gradually include daytime surgery and eligible outpatient treatment of Chinese and Western medicine diseases into the scope of medical insurance fund disease payment. Establish and improve the negotiation mechanism, based on the past cost data and the payment ability of medical insurance fund, scientifically and reasonably determine the payment standard of Chinese and Western medicine diseases on the basis of ensuring the curative effect, guide the use of appropriate technology, and save medical expenses. Do a good job in linking the policies of charging and paying according to diseases, and reasonably determine the charging and paying standards, which will be shared by the medical insurance fund and individuals. Accelerate the formulation of technical specifications for medical service projects, and realize the unification of the name and connotation of medical service projects nationwide. Gradually unify the disease classification coding (ICD-1), surgery and operation coding system, clarify the writing norms of medical records and the first page of medical records, and formulate and improve industry technical standards such as clinical pathways that meet the basic medical needs, so as to lay a good foundation for the implementation of payment by disease.

(3) to carry out the trial of paying by groups related to disease diagnosis. Explore the establishment of a group payment system based on disease diagnosis. According to the severity of the disease, the complexity of treatment methods and the actual level of resource consumption, we should group the diseases, adhere to the openness of grouping, grouping logic and basic rates, and determine, adjust and improve the relative price relationship between the groups in combination with the actual situation. We can measure and evaluate the cost and curative effect of medical institutions based on disease diagnosis related grouping technology, strengthen the horizontal comparison between different medical institutions with the same disease group, improve the medical insurance payment mechanism by using the evaluation results, and promote medical institutions to improve their performance and control costs. Accelerate the improvement of the refined management level of medical insurance, and gradually use the disease diagnosis related groups for actual payment and expand the application scope. All medical expenses including medical insurance fund and personal payment are included in the group fees and payment standards related to disease diagnosis.

(4) Improve the payment methods such as per head payment and per bed day payment. Support the construction of graded diagnosis and treatment mode and family doctor contract service system, rely on primary medical and health institutions to implement outpatient co-ordination and pay by head, and promote primary medical and health institutions to provide quality medical services. All co-ordination areas should clarify the scope of the basic medical service package based on per capita payment, and ensure the payment of drugs, basic medical service fees and general medical treatment fees in the medical insurance catalogue. Gradually start with chronic diseases with clear treatment plan standards and evaluation indicators such as diabetes, hypertension and chronic renal failure, carry out special chronic diseases to pay by head, and encourage medical institutions to do a good job in health management. Conditional areas can explore paying the outpatient fund of contracted residents to primary health care institutions or family doctors' teams per head. If patients are referred to hospitals, primary health care institutions or family doctors' teams will pay a certain referral fee. For mental illness, hospice care, medical rehabilitation and other diseases that require long-term hospitalization and the average daily cost is relatively stable, we can pay by bed day, and at the same time strengthen the assessment of the average hospitalization days, average daily cost and treatment effect.

Legal basis

Main contents of Article 2 of the Guiding Opinions of the General Office of the State Council on Further Deepening the Reform of Payment Methods of Basic Medical Insurance (Guo Ban Fa [217] No.55)

(1) Implementing multiple and compound medical insurance payment methods. According to the characteristics of different medical services, we will promote the classification reform of medical insurance payment methods. For in-patient medical services, they are mainly paid according to diseases and related groups of disease diagnosis, and long-term and chronic in-patient medical services can be paid according to bed days; For primary medical services, you can pay per head, and actively explore the combination of per head payment and chronic disease management; For complex cases and outpatient expenses that are not suitable for package payment, they can be paid according to the project. Explore payment methods that meet the characteristics of Chinese medicine services and encourage the provision and use of appropriate Chinese medicine services.

(2) Pay attention to diseases. In principle, the treatment plan and admission standards are relatively clear, and the treatment technology is relatively mature. Gradually include daytime surgery and eligible outpatient treatment of Chinese and Western medicine diseases into the scope of medical insurance fund disease payment. Establish and improve the negotiation mechanism, based on the past cost data and the payment ability of medical insurance fund, scientifically and reasonably determine the payment standard of Chinese and Western medicine diseases on the basis of ensuring the curative effect, guide the use of appropriate technology, and save medical expenses. Do a good job in linking the policies of charging and paying according to diseases, and reasonably determine the charging and paying standards, which will be shared by the medical insurance fund and individuals. Accelerate the formulation of technical specifications for medical service projects, and realize the unification of the name and connotation of medical service projects nationwide. Gradually unify the disease classification coding (ICD-1), surgery and operation coding system, clarify the writing norms of medical records and the first page of medical records, and formulate and improve industry technical standards such as clinical pathways that meet the basic medical needs, so as to lay a good foundation for the implementation of payment by disease.

(3) to carry out the trial of paying by groups related to disease diagnosis. Explore the establishment of a group payment system based on disease diagnosis. According to the severity of the disease, the complexity of treatment methods and the actual level of resource consumption, we should group the diseases, adhere to the openness of grouping, grouping logic and basic rates, and determine, adjust and improve the relative price relationship between the groups in combination with the actual situation. We can measure and evaluate the cost and curative effect of medical institutions based on disease diagnosis related grouping technology, strengthen the horizontal comparison between different medical institutions with the same disease group, improve the medical insurance payment mechanism by using the evaluation results, and promote medical institutions to improve their performance and control costs. Accelerate the improvement of the refined management level of medical insurance, and gradually use the disease diagnosis related groups for actual payment and expand the application scope. All medical expenses including medical insurance fund and personal payment are included in the group fees and payment standards related to disease diagnosis.

(4) Improve the payment methods such as per head payment and per bed day payment. Support the construction of graded diagnosis and treatment mode and family doctor contract service system, rely on primary medical and health institutions to implement outpatient co-ordination and pay by head, and promote primary medical and health institutions to provide quality medical services. All co-ordination areas should clarify the scope of the basic medical service package based on per capita payment, and ensure the payment of drugs, basic medical service fees and general medical treatment fees in the medical insurance catalogue. Gradually from diabetes, hypertension, chronic renal failure and other treatment standards, evaluation indicators clear.