China accelerates the reform of DRG payment and gradually expands coverage

DRG collects and pays, which is also called “receiving and paying according to the disease diagnosis related group”. It is divided into several groups according to the severity of the disease, the complexity of the treatment method and the resource consumption, and the payment method of pricing and payment is set separately. This year is the first year of promoting DRG payment and payment reform from the national level. How to establish a DRG payment and payment system suitable for China's institutional advantages has become the focus of the industry. On September 14, Ma Xiaowei, deputy director of the National Health and Family Planning Commission, said at the China DRG collection and payment conference held here that the reform of medical insurance payment is an important task of the 13th Five-Year Plan for medical reform, and it is necessary to play the reform of payment and payment in the medical reform. Leverage, constantly explore and create reforms including the outpatient, inpatient, community and other medical systems. Do top-level design from the national level, take into account the pilot first, and promote the reform of payment and payment methods, and gradually expand the coverage.

Photo of the conference

Accelerate the establishment of a compound payment mechanism based on DRG payment for hospitalization

In the process of deepening medical reform, the reform of the payment system has always been the focus and difficulty. Practical experience at home and abroad has shown that the system for collecting and collecting diseases according to the disease (DRG) has played an active role in controlling the unreasonable growth of medical expenses, promoting medical institutions to reduce costs, and improving the quality of medical services.

“Diagnosis, correlation, and grouping by disease are three key factors. We have sorted out all the diseases that can be diagnosed as diseases. After 735 experts have established a national disease diagnosis terminology for two years, it is called the national disease diagnosis standard terminology. This is the first time that the name of the disease diagnosis has been unified for the C-DRG group." Zhang Zhenzhong, honorary director of the National Health and Family Planning Commission Health Development Research Center, said that the nationwide collection and payment system for disease diagnosis is based on international experience and part of China. On the basis of the implementation of DRG experience and lessons, the provinces and municipalities have closely integrated China's specific national conditions and medical security system and the actual situation of public hospital compensation mechanisms, and created a set of public welfare payment systems for national applications.

According to Fu Wei, director of the Center for Health Development Research of the National Health and Family Planning Commission, since 2015, the state has successively launched a series of policies related to the reform of the medical insurance payment system. In June this year, the National Health and Family Planning Commission held a pilot meeting of the DRG fee collection reform pilot in Shenzhen, and determined that 36 medical institutions in Sanming, Shenzhen, Karamay and Fujian provinces had piloted DRG reforms.

Zu Guoying, deputy inspector of the Social Security Department of the Ministry of Finance, said that the DRG payment reform will be fully implemented in China. The Ministry of Finance will actively participate in the formulation of relevant policies, summarize the experience of typical regions, and promote the establishment of a compound payment mechanism based on DRG payment.

“Practice shows that paying for DRG is a tool for modern health management, and it is an effective way to directly manage inpatients.” Ma Xiaowei said that DRG payment reform is a system engineering involving the entire health industry, the basis for health information. The unified regulation of construction and health standards, the diagnosis and treatment behavior of medical institutions, and the promotion of cost-based dynamic value adjustment mechanisms will play a positive role. It is precisely because of this that the effective promotion of DRG's payment and payment reform needs to be closely coordinated with other reform-related health policies, such as coordination with grading medical treatment and coordination with medical insurance policies.

It is especially important to guide hospitals and doctors to take the initiative to participate in the reform.

Fan Minmin, deputy director of the Finance Department of the National Health and Family Planning Commission, said that as a global macro, meso and micro-economic lever, DRG's payment method has a powerful function, which can mobilize many parties and achieve the five goals of comprehensive medical and health reform. First, the overall package is conducive to controlling the unreasonable rise of medical expenses; the second is the integration of payment and payment, which is beneficial to the masses of the people; the third is the standardization of standards, which is conducive to the formation of a unified system of national norms; Promote the formation of a grading diagnosis and treatment pattern; Fifth, optimize supervision, which is conducive to the establishment of a modern hospital management system.

According to Fan Minmin, the Finance Department of the National Health and Family Planning Commission has been working on the basic research of payment and payment specifications for many years. So far, it has taken the lead in formulating three types of payment and payment specifications, and has completed the National Medical Service Price Project Regulations and "Technical Specifications for the Collection and Payment of Diseases" and "Regulations for Collection and Payment of Diseases by Diseases".

“Currently C-DRG fee collection and C-DRG fee collection reform pilot work, Fujian Sanming, Guangdong Shenzhen and Xinjiang Karamay as pilot cities, Fujian Medical University affiliated Union Hospital, Fuzhou First Hospital and Xiamen First Hospital As a pilot hospital to carry out pilot work, we call the 'three +3' pilot pattern. Recently, the Tangshan and Handan cities in Hebei Province are also in the pilot preparation stage.” Fan Yimin said that the DRG pilot is conditional, not a one-step thing, at least There are four requirements: First, the leaders should attach great importance to it; second, the “three guarantees in one” should be in place; third, the level of informatization should be on the upper level; fourth, the level of fine management should be on the level, so DRG is in the process of active and steady. Advance.

Fan Minmin said that in the next stage, it is especially important to do a good job in piloting, improve reform policies, and guide hospitals and doctors to actively participate in reforms. In the future, further research and development of incentive policies will be needed to provide appropriate financial or non-financial incentives for medical institutions to fully mobilize the enthusiasm of hospitals and medical personnel to ensure the successful completion of reform tasks.

Zhang Zhenzhong stressed that to promote the reform of the DRG payment system, we must adhere to some principles, including the implementation of DRG payment coverage, the combination of uniformity and difference, the future hospital revenue increase lies in cost management, improve medical quality, safety and efficiency, and establish medical reform goals. Consistent compensation system, open and transparent continuous dynamic improvement. Zhang Zhenzhong said, "In the process of advancing, we hope that it is Baidu map in the field of payment and charging. We will improve it and improve it in the process of use."

Building an integrated service system is the future development trend

Last year, China issued the "Healthy China 2030" Planning Outline, which clarified the direction and path of China's health care reform and development in the next fifteen years. Among them, in the five major areas of health optimization services, it is proposed to build an integrated service system.

Zhuang Ning, deputy director of the Department of System Reform of the National Health and Family Planning Commission, said that building an integrated service system is also an international future development trend. The grading diagnosis and treatment system that China has vigorously promoted in recent years is also a key link in the integrated service system. Zhuang Ning said that there are five aspects that need to be focused on building an integrated service system. First, the "people-oriented" as the core of the entire service; the second is the team-based population health responsibility system; the third is health information; the fourth is to change the hospital-focused health care model, the grassroots should be placed The first is to improve the grassroots ability; the fifth is patient participation and self-management. The integrated service system is a matter for both the supply and the demand. It requires the joint efforts of the society, the government and the individual to achieve the improvement of the health of the whole people, and to create a complete and reasonable system. Integrated medical service system.

Zhuang Ning also emphasized the "four community building", namely the service community, the responsibility community, the interest community and the management community, so that the four-in-one common service orientation is truly formed. In particular, the community of interests is the most powerful link between the two. The payment method of DRG is a very powerful point to form a community of good interests. Through the innovation of payment reform, financial investment, personnel compensation and other mechanisms of medical insurance, the medical association will establish a mechanism for sharing and allocating benefits, and at the same time, it must support the reform of the financial compensation mechanism, so that the external pressure policy will truly rise to every medical staff. The enthusiasm is thus effectively transformed into a service that benefits the people.

It is reported that China DRG collection and payment conference is guided by the National Health and Family Planning Commission, the National Health and Family Planning Commission Finance Department and the National Health and Family Planning Commission Medical and Hospital Administration Bureau, the National Health and Family Planning Commission Health Development Research Center, China Health Economics Association Health Service The Cost and Price Professional Committee and the China International Science and Technology Conference Center. International experts from the United States, Australia, Germany, France, and Denmark made keynote speeches on the experience and experience of DRG implementation and suggestions for China. Experts from pilot areas such as Shenzhen, Sanming and Karamay also gave special lectures on issues related to the C-DRG pilot. On the same day, the National Health and Family Planning Commission's Center for Health Development Research was also appointed by WHO as the “World Health Organization Collaborative Center for Chinese Classification Terms and Standards” and held an unveiling ceremony.

Source: Xinhuanet

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