Medical cost control is a long-term national policy.

Comprehensively implement the diversified and composite medical insurance payment method that focuses on payment based on disease type.

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.

The role of medical expense control: 1. The main goal of medical expense control is to squeeze out unreasonable medical expenses.

For medical consumables, we must not only squeeze out the "excessive volume", but also squeeze out the long-standing "inflated prices."

Which expenses are normal medical needs and which are excessive medical needs should be treated scientifically and differently, and each region and hospital will be different.

2. Reform indicators need to be broken down layer by layer.

For example, indicators such as drug proportion and consumption proportion are not comparable between general hospitals and specialist hospitals, and between hospitals of different levels. Assessment based on a single indicator does not comply with the basic rules.

At the hospital level, the long-term extensive management method under the project-based payment system should be changed, clinical pathways should be optimized, hospital operation efficiency should be improved, and reasonable and appropriate balances should be obtained for distribution.

3. In addition, establishing a hierarchical diagnosis and treatment system to form a hierarchical diagnosis and treatment model with primary diagnosis, two-way referral, acute and slow treatment, and linkage between upper and lower levels is also an important measure to improve the efficiency of medical resource utilization, alleviate the cost of medical treatment, and achieve the goal of controlling medical expenses.

Target.

Extended information: Policies related to medical cost control 1. In 2015, the State Council issued the "Guiding Opinions on the Pilot Comprehensive Reform of Urban Public Hospitals".

2. In 2016, the State Council issued the "Thirteenth Five-Year Plan for Deepening the Reform of the Medical and Health System". Both policies emphasized that by 2017, the proportion of medicines (excluding traditional Chinese medicine pieces) in public hospitals in pilot cities will be reduced to 30% overall.

around; the health materials consumed per 100 yuan of medical income (excluding drug income) dropped to less than 20 yuan.

The latter further clarified that “by 2017, the growth rate of medical expenses in public hospitals nationwide will strive to drop below 10%.”

3. At the end of September 2017, China has completely abolished drug markups in public hospitals.

According to the "Opinions on Comprehensively Deepening the Reform of the Price Mechanism", the next step will be to consolidate the results of the elimination of drug mark-ups, further cancel the mark-ups on medical consumables, and optimize and adjust the prices of medical services.

4. On December 22, 2017, the official website of the National Health and Family Planning Commission issued the "Notice on Providing Medical and Health Services to Ensure the Quality of Medical Services during the New Year's Day and Spring Festival in 2018", which clearly pointed out that scientific design should be based on the different economic and social development conditions of various regions.

We must set goals for controlling unreasonable growth in medical expenses and do not adopt a “one size fits all” approach.

Stop focusing on the results and not the process.