Original title: Accelerate the reform of medical insurance payment mode (theme)

Xinjiang will strive to achieve full coverage of medical institutions through reform of medical insurance payment mode this year (subtitle)

Urumqi Evening News (full media reporter Shi Chuanzhi) The autonomous region will accelerate the reform of the medical insurance payment method, and this year will strive to achieve the DRG/DIP payment method to cover all medical institutions that meet the conditions to carry out inpatient services.

DRG payment refers to payment according to disease diagnosis related groups, and patients are divided into diagnosis related groups with similar clinical symptoms and resource consumption according to disease diagnosis, disease severity, treatment methods and other factors. DIP payment refers to payment by disease score. It is a combination of main diagnosis and treatment methods of diseases to form disease types based on big data application under the total budget mechanism. DRG/DIP payment is a more scientific and refined medical insurance payment mode, which can avoid excessive medical treatment and reduce the burden of patients' medical care.

From May 22 to 23, the Xinjiang DRG/DIP medical insurance payment reform conference was held. The reporter learned from the meeting that at present, the reform of DRG/DIP payment mode is accelerating nationwide, and the quality and efficiency of the use of medical insurance funds are constantly improving. The autonomous region will carry out the pilot reform of payment methods in 2021. At present, 15 coordinated regions (including autonomous regions) have all carried out DRG/IP payment reform, and 1300 medical institutions have implemented DRG/IP payment, accounting for 86% of the total number of medical institutions that should be included in the payment reform.

In the past three years, the autonomous region has determined the payment standard according to the score of disease group and disease type, which has stimulated the endogenous motivation of hospitals to improve service quality, actively control costs, and reduce resource waste. The increase of patients' self paid medical expenses has decreased significantly, and the medical satisfaction of insured people has continued to increase. The increase of DRG/DIP basic disease group has helped common and chronic diseases gradually sink to counties, cities and towns for treatment, played a guiding role in the value purchase of medical insurance funds, and the coordinated development and governance of medical insurance, medical treatment, and medicine have shown initial results.

Urumqi is one of the 30 pilot cities for national DRG payment. At present, there are 113 medical institutions that have actually paid for DRG. The proportion of drugs in medical institutions has steadily declined, the proportion of medical service costs has significantly increased, medical resources have been reasonably utilized, and the average medical cost per time, the amount of personal burden of average medical cost per case, and the average number of days in hospital have all declined.

Among them, the average cost of hospitalization decreased from 13600 yuan in 2022 to 11400 yuan in 2023, and the average medical cost burden of individuals decreased from 4610.05 yuan in 2022 to 3699.34 yuan in 2023. Calculated by 583000 inpatients of Urumqi insured persons in 2023, the burden of personal medical expenses will be reduced by 531 million yuan.

It is understood that more than 600 experts from the National Medical Security Bureau and the DRG/DIP Technical Steering Group, as well as representatives from 12 provincial and municipal medical security bureaus, including Beijing and Guangdong, and medical security bureaus and medical institutions in autonomous regions attended the conference. With the theme of "comprehensively promoting the reform of medical insurance payment and realizing the coordinated development and governance of the three medical services", the conference aims to build an exchange platform for the reform of DRG/DIP payment methods, promote exchanges and cooperation within the industry, and better provide patients with more scientific and reasonable medical services.