“Control fees” and “price reduction” will re-enact the highlight of the 2019 medical insurance reform. Xinhua News Agency's “control fee” and “price reduction” go hand in hand, will re-enact the 2019 medical insurance reform highlights, and relevant policies are being introduced intensively. The “Economic Information Daily” reporter was informed that the growth rate of China's medical insurance fund expenditure is close to 20%, higher than the fund income growth rate; the special action against fraud fraud continues; the current medical insurance fund supervision and management approach has entered the drafting stage, not long after Will be introduced. On the other hand, the sword refers to “expensive medical treatment” and the reform of medical insurance payment methods has entered a deepening period. Among them, the multi-component medical insurance payment method based on disease-based payment will be comprehensively promoted in 2019, and dozens of cities across the country will focus on exploring the payment methods for disease diagnosis related groups (DRGs).
According to the latest data from the Ministry of Human Resources and Social Security, from January to November 2018, medical insurance fund income was 1,806.28 billion yuan, and medical insurance fund expenditure was 1,474.99 billion yuan. In the same period of last year, the data of this group were 157.183 billion yuan and 12305.4 billion yuan respectively. The income growth rate of the medical insurance fund reached 14.9%, the growth rate of expenditure reached 19.9%, and the growth rate of expenditure was 5 percentage points higher than the income growth rate.
“The expenditure of medical insurance funds is rigid, the growth rate of medical insurance funds is higher than the growth rate of income, and the pressure on medical insurance funds is further increasing.” Chen Qiulin, director of the Social Security Research Office of the Institute of Population and Labor Economics of the Chinese Academy of Social Sciences, told the Economic Information Daily. .
At the same time, fraudulent fraudulent access to medical insurance funds still occurs. Combating fraud insurance as the first important special action since the establishment of the National Medical Insurance Bureau is still continuing. Yan Qinghui, director of the Office of the National Medical Insurance Bureau, said earlier that the first function of medical insurance is to guarantee the function, and definitely consider the balance and sustainability of the fund. The price of drugs and the protection of fraudulent insurance are actually for the sustainability of the fund and to make better use of the efficiency of existing funds. Duan Zheng, deputy director of the Fund Supervision Department of the National Medical Insurance Bureau, revealed that the National Medical Insurance Bureau is currently drafting the Measures for the Supervision and Administration of Medical Insurance Funds to further strengthen the medical insurance rule of law.
Guan Bo, an associate researcher at the China Institute of Macroeconomic Research, told the reporter of the Economic Information Daily that China's medical insurance covers the entire population and continues to rely on the expansion of the area to increase revenue. With the expansion of the medical insurance catalogue and the further aging of the system in the system, At the same time as the system guarantees the improvement of people's livelihood, the rigid pressure of spending is further increased. It is necessary to speed up the improvement of basic medical insurance financing and treatment determination policies. “It is necessary to further improve the efficiency of the use of medical insurance funds, curb excessive medical care, eradicate fraudulent behavior, and pay enough space for more life-saving drugs and effective medical activities to better implement the system's livelihood security function.”
In terms of enhancing the sustainable development of medical insurance, there have been many actions in recent days. The Seventh Session of the Standing Committee of the 13th National People's Congress, held on December 23, 2018, reviewed the “Report on the Summary of the Pilot Work on the Integration of Maternity Insurance and Basic Medical Insurance for Staff and Workers”. On December 29, the “Social Insurance Law of the People's Republic of China” was revised for the first time after 8 years, and the corresponding institutional arrangements were made for the merger of the two insurances. Chen Qiulin said that the combined implementation of maternity insurance and medical insurance is conducive to expanding the coverage of maternity insurance, strengthening the mutual fund of the fund while expanding the entire fund pool and enhancing the sustainable development of medical insurance.
“Control fees and price cuts have become an important task in the current medical insurance reform.” Chen Qiulin said. On the one hand, through the “control fee”, to enhance the sustainable development of medical insurance, on the other hand, through “price reduction”, reduce the burden of medical treatment for the people, and deepen the reform of medical insurance payment methods is an important way to achieve.
On December 20, 2018, the National Medical Insurance Bureau officially promoted pilot countries for disease diagnosis related groups (DRGs). Each province can recommend 1-2 cities as national pilot cities to regulate medical service behavior, guide medical resource allocation, and control. Medical expenses have grown unreasonably.
On December 29, the National Health and Health Commission and other 12 ministries and commissions jointly issued a notice stating that the reform of medical insurance payment methods should be accelerated, and the multi-component medical insurance payment method based on disease-based payment should be comprehensively promoted, and the project-based payment should be gradually reduced; Payment by disease diagnosis related group (DRGs).
According to industry insiders, payment by disease type and DRGs payment is a mechanism for prepayment. If the actual cost of treatment exceeds the relevant regulations, it needs to be digested by the hospital itself. Therefore, it will be stricter than the current control drug ratio and restrictions on auxiliary drugs. Effective means of control fees.
In fact, in the past 2018, Sichuan, Jiangsu, Shanxi, Guizhou, Hebei, Hubei, Guangdong and other provinces have clearly revised the details of the reform of medical insurance payment methods. For example, Jiangsu Province proposed that by 2020, the reform of medical insurance payment methods will cover all medical institutions and medical services, and the number of paid for diseases will be no less than 200, and the proportion of payment by project will drop significantly. Beijing recently launched a deepening medical reform program to further abolish medical institutions' medical consumables and adjust the price of more than 1,600 medical service projects, which will be implemented in mid-June 2019.
Guan Bo pointed out that the reform of payment methods is the key combination of the three medical linkages, allowing the people to enjoy better quality and better medical services. The first is to refine the medical insurance control fees and tools, and to promote the medical insurance costs more. The second is to standardize medical service performance evaluation tools, to promote medical services more quality and efficient; the third is to guide the rational use of drugs, consumables policy lever.
In addition to “control fees” and “price reductions”, experts also said that there are still many hard-core tips for health care reform. “For example, the institutional structure needs to be re-optimized, and the security function of the medical insurance personal account needs to be further explored; the formation of a stable operation and promoteable care security policy system needs more exploration; in solving the problem of expensive medical treatment, promoting the reform of public hospitals and other medical reform priorities. In the field, the three medical linkages need more policy means,” Guan Bo said.
(The original title is “The fee reduction, the medical insurance reform, the main event, and the two sides go hand in hand”)
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