In order to make people stop "expensive" and "difficult" to see a doctor, medical insurance payment is about to usher in an important reform. Where is the specific change? How to change it? Where is the reform of medical insurance payment?

Implement a variety of composite medical insurance payment methods.

For in-patient medical services, it is mainly paid according to the relevant population of diseases and disease diagnosis, and long-term and chronic in-patient medical services can be paid according to bed days.

For primary medical services, we can implement per capita payment and actively explore the combination of per capita 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.

Pay attention to paying by disease.

Gradually include day surgery and qualified outpatient treatment of Chinese and western diseases into the scope of payment of medical insurance funds.

Establish and improve the negotiation mechanism, based on the past cost data and the payment ability of the medical insurance fund, and on the basis of ensuring the curative effect, scientifically and reasonably determine the payment standards for diseases of Chinese and Western medicine, and guide the use of appropriate technologies.

Do a good job in linking up the charging and payment policies according to diseases, and reasonably determine the charging and payment standards, which shall be shared by medical insurance funds and individuals.

Carry out a pilot program to pay for groups related to disease diagnosis.

According to the severity of diseases, the complexity of treatment methods and the actual level of resource consumption, diseases are grouped, and the openness, logicality and basic rate of grouping are adhered to.

With the support of disease diagnosis related grouping technology, we can measure and evaluate the diagnosis and treatment cost and curative effect of medical institutions, strengthen the horizontal comparison between different medical institutions in the same disease group, and improve the medical insurance payment mechanism by using the evaluation results.

Gradually use people related to disease diagnosis for actual payment and expand the scope of application.

Group expenses and payment standards related to disease diagnosis, including all medical expenses paid by medical insurance funds and individuals.

Improve the payment methods such as paying by head and paying by bed day.

All co-ordination areas should clarify the scope of 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 chronic diseases with clear treatment standards and evaluation indicators, special chronic diseases will be paid per head.

Conditional areas can explore the payment of the contracted residents' outpatient fund to grassroots medical and health institutions or family doctors. If the patient is referred to the hospital, the primary health care institution or the family doctor team 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, you can pay by bed day, and at the same time strengthen the assessment of the average hospitalization day, average daily cost and treatment effect.

Strengthen the supervision of medical insurance on medical behavior

According to the functional orientation and service characteristics of various medical institutions at all levels, a scientific and reasonable evaluation system is classified and improved, and the evaluation results are linked to the payment of medical insurance funds.

The assessment indicators of TCM medical institutions should include the proportion of TCM service provision.

Conditional local medical insurance agencies can prepay a part of the medical insurance fund to medical institutions as agreed, so as to ease the pressure of fund operation.

Seeing such changes, the lives of ordinary people are guaranteed, and medical care is guaranteed, so that they can live a better life.