This article is from WeChat public account: eight o’clock Jian Wen (ID: HealthInsight) , author: Jian Wen Intelligence, FIG title From: Vision China
△健闻智库 Popular science video “DRGs is the end”
What is DRGs and what does it do?
How is China’s introduction of DRGs running?
How will DRGs develop next and how will it affect us?
For these topics, 八点健闻 has launched a series of in-depth reports, from concept to practice, from historical sources to pilot re-investments, covering all aspects of DRGs. Put together, is a small encyclopedia of Chinese DRGs.
Here are the eight-point news about DRGs:
1. Past and Present of China DRGs: An Incoming Medicare Payment Mechanism How to localize
The study of DRGs in China began in 1988, and the principal was Huang Huiying, then director of the Beijing Hospital Research Institute. She led 10 major hospitals such as Concord and Tiantan to conduct DRGs research, and wanted to see if this set of foreign popular methods could be used for hospital performance management.
The Chinese-style DRGs pilot, which was launched in Beijing around 2006, has gradually formed multiple models in various places.
“A thousand readers, there are a thousand Hamlet. This sentence also applies to the practice of DRGs in China now.” An expert who has studied DRGs for many years, when trying to explain the reform of China’s DRGs with many Chinese models, said .
At the end of 2018, the newly established National Medical Insurance Bureau issued Circular No. 27 – the DRGs payment pilot has since been led by the National Medical Insurance Bureau.
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This logic, in line with the latest methodology of the Chinese medical insurance payment mechanism DRGs – “Big Data by Disease Score” is the same. The “big data disease score” approach finds similar patients based on data such as disease diagnosis, treatment operations, and personal characteristics, and calculates treatment costs for this patient based on their average cost. This method is also commonly known as big data DRGs.
The same kind of diagnosis and treatment is divided into one group, and one group is divided into one payment “one price”, which is the basic methodology of traditional DRGs.
Big Data DRGs simply don’t want a grouper. When a patient goes to the hospital to see a doctor, he can automatically match a reasonable treatment cost with similar patient population data.
3. Medicare and hospital have been quarreling for 20 years, the city’s DRGs are ahead of the country
In early 2015, at a meeting to discuss the medical insurance budget, Liuzhou’s two top three hospitals, the People’s Hospital and the Workers’ Hospital, quarreled on the spot for the distribution of the “high-cost hospitalization” medical insurance payment program. Points to 15The workers’ hospitals with more than 00 million yuan were not convinced that the people’s hospitals with similar levels were more than 30 million yuan. When the dispute was over, Li Ningning, the president of the People’s Hospital, said casually, “Then we got DRGs!”
Since then, Liuzhou has embarked on a three-year exploration of DRGs.
The quarrel will of course still have. For the rationality of the DRGs grouping, the standard for the cost, and so on. Before the Spring Festival in 2019, at a meeting of local hospitals and social security bureaus, when some hospitals began to make arguments for some unreasonable grouping, a person in charge of the Liuzhou Social Security Bureau spoke emotionally.
“DRGs have come to this day, I admit that there are many problems, and they need to be improved. But DRGs should be the best way we can find now. If you are not satisfied, we will go back to the total amount of prepayment. Ok?”
After listening to this, the representatives of the hospital have expressed their feelings, “If you don’t go back, it will be fine!”
4. C-DRG Sanming pilot results were first disclosed, hospital medical insurance team is 诀窍
Fujian Sanming’s C-DRG officially launched in January 2018. Local patients hospitalized in county hospitals only pay 30% of the cost in the C-DRG pricing package (town residents in the tertiary hospitals 50% self-pay ratio), you can leave the hospital. It has realized the related issues of the same-level medical institutions, the same disease, the same treatment, the same price, one-stop solution and medical insurance settlement. This means that Sanming’s health and medical insurance through the C-DRG, the realization of medical insurance information docking and mutual recognition.
ForIn terms of medical insurance, the most practical goal in 2019 is to ensure the safety of medical insurance funds, and Wei Jian’s goal is to change the behavior of doctors and make them more reasonable. DRGs are the technical bridge connecting Weijian and medical insurance. However, Weijian and Medicare are still based on their different work priorities.
5. Dare to present the “DRG package price” to the patient, only Sanming has done it in the country
Since the National Health Insurance Agency announced in early June that the “sick class=”text-remarks” label=”remarks”>(DRG) 30 cities piloted the news, the market Probable enemy. The industry has speculated and commented that many people think that the hospital will have no motivation.
As a national leader in medical reform, Sanming City, Fujian Province, has tried different versions of DRG in the past few years and is currently listed as an “important observation point” by the National Health Insurance Bureau pilot document. Its experience shows that a reasonable DRG system design can give hospitals the incentive to actively reform.
Guangzhou has implemented big data DRGs since 2018. According to the disease group + treatment combination, big data DRGs group more than 10,000, covering more than 90% of cases.
Because the grouping incorporates the treatment method, higher-cost clinics can be paid, and hospitals are more able to open up their hands to practice new technologies.
The random pricing of medical services in past hospitals was constrained by the “average price” generated by Big Data Actuarial. “Black box operation” lost space. In the year of comprehensive promotion of big data DRGs, Guangzhou City’s 2018 savings in medical insurance costs nearly 10%, about 11 billion.
Within the province of Zhejiang, there have been two versions of DRGs in parallel in recent years: the Shanghai Shenkang version introduced by the Provincial Health and Health Commission, and the Jinhua version of the Jinhua Medical Insurance Department.
One of the great experiences of Shanghai Shenkang Edition is to borrow DRGThe s system implements quantitative assessments of hospitals at all levels and promotes grading diagnosis and treatment. The Jinhua version is effective in medical insurance control fees. After one year of implementation, the fund growth rate in 2017 was controlled to 7%, and even caused high-level attention.
In the end, the decision makers referred to the Jinhua version of the DRGs disease group point method, combined with the actual situation in Zhejiang to carry out transformation, and promoted in the province, starting from January 2020. The final promotion version includes more than 1,700 disease groups, and dynamic adjustment of DRGs grouping will be performed every two to two years.
8. The Medical Insurance Bureau takes the lead and the DRG reform national team debut
In October of this year, the National Health Insurance Bureau issued the Notice on Printing and Distributing Diseases Related Groups (DRG) Paid Country Pilot Technical Specifications and Grouping Plan 》, includes the National Medical Security DRG Grouping and Payment Technical Specifications and the National Medical Security DRG(CHS-DRG) grouping plan.
This means that after a year of preparation, the national team for the DRG payment reform officially debut.
The reform also has a clear timeline: in 2019, the medical insurance bureau completed the top-level design, the 2020 national pilot city simulation operation, and the 2021 DRG practical application.
This article is from WeChatPublic number: Everything (ID: HealthInsight) , author: Jian Wen think tank