Medical insurance fee control is the “first shot” of the medical reform in 2018, and many places have started charging based on disease type.

As one of the highlights of the medical reform, medical insurance fee control has begun to launch 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 based on disease.

According to incomplete statistics from reporters, nearly two-thirds of provinces across the country have implemented or are piloting disease-based charging.

Industry insiders said that this change means that my country's medical reform is taking a substantial step.

Charges are based on disease type, that is, from the time the patient is admitted to the hospital, receives standardized diagnosis and treatment according to the treatment management process of the disease type, and is discharged after meeting the clinical efficacy standards, all the diagnosis, treatment, surgery and other expenses incurred during the entire process are all packaged and charged at once.

The hospital charges according to this standard, and the medical insurance fund and insured patients pay according to the prescribed proportion.

Since 2017, favorable policies supporting disease-based payment have been continuously introduced.

In early 2017, the National Development and Reform Commission, the Health and Family Planning Commission, and the Ministry of Human Resources and Social Security jointly issued the “Notice on Promoting Disease-Based Charging Work.”

In mid-2017, the General Office of the State Council issued the "Guiding Opinions on Further Deepening the Reform of Basic Medical Insurance Payment Methods", requiring that starting from 2017, a diversified and comprehensive medical insurance payment method focusing on disease-based payment will be fully implemented.

At the end of 2017, many provinces such as Anhui and Shanxi successively introduced policies, and the expansion of the pilot scope of disease-based payment was significantly accelerated. Entering 2018, the progress of each province has been greatly accelerated.

Judging from the current implementation situation in various provinces, the "packaged" medical treatment packages launched cover more than 100 types of diseases, most of which are common diseases.

"Charging according to disease type is beneficial to patients. It can reduce the patient's burden of medical treatment, and at the same time, the cost of treatment can be predicted in advance." A doctor from a public hospital in Shandong that has tried charging according to disease type told a reporter from the Economic Information Daily that in the case of acute and simple cases,

Take appendicitis as an example. Previously, the treatment fee in Jinan's top tertiary public hospitals mostly fluctuated below 12,000 yuan, while the fee based on the disease type dropped to 10,000 yuan.

Gu Xuefei, an associate researcher at the Health Development Research Center of the National Health and Family Planning Commission, believes that the medical insurance management department has reformed the payment method and implemented multiple comprehensive payment methods such as bed-day, disease type, and total prepayment. The principle is to "retain the surplus and reasonably share the overspending."

The purpose is to improve the efficiency of fund use and hope that hospitals can proactively control expenses while ensuring medical quality 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 there is a deadlock between increasing medical service fees and reducing drug costs, making it difficult to achieve substantial progress: before the price of medical services is not increased, it is impossible to effectively

Reduce hospital drug costs and test charges, otherwise hospitals will not survive.

However, until hospital drug costs are effectively reduced, government departments dare not raise medical service prices for fear of causing further increases in medical costs.

As a deeply aging society approaches, less revenue and more expenditure will become the new normal for medical insurance funds.

In fact, for the medical insurance department, there is not much room for open source at present, and cost control has become a necessary path for medical reform.

Zhu Hengpeng said that under the conditions of universal medical insurance, a considerable proportion of medical expenses are paid by medical insurance institutions. In order to avoid excessive medical treatment tendencies on both sides of the doctor and patient, payment methods based on service items should be avoided as much as possible, and a series of other more comprehensive payment methods should be adopted.

Scientific payment model.

Pilot projects in some areas of the country have also achieved remarkable results.

For example, urban and rural residents' medical insurance and urban employee medical insurance can try to adopt a capitation payment system for outpatient payment, and a system that combines total prepayment and disease-based payment for inpatient payment.

These systems can effectively mitigate overmedication and overtesting.