The "package price" in the hospital for hospitalization is implemented in 4 hospitals in Quanzhou to implement DRG receivables

Quanzhou Evening News · Quanzhou Tong Client September 21 (Southeast Morning Post reporter Xu Yimei Correspondent Wang Yueqing) Recently, the reporter learned from the Quanzhou Medical Insurance Bureau that in order to promote the reform of medical insurance payment methods, effectively improve the efficiency of fund use, control unreasonable medical expenses Breakfast, according to the "Notice on Adjusting the Related Groups Relevant Group Requesting and Payment Standards for Diagnostic Diagnosis Diagnosis Diagnosis" issued by the Fujian Provincial Medical Insurance Bureau. According to the disease diagnosis related group (DRG) receipt policy, Shishi Hospital and Quangang District Hospital will implement the DRG payment policy from October 15. After the four hospitals implemented the DRG payment policy, the inpatient patients were diagnosed and treated with a "packaging price", and they had a number of medical treatment.

"Packaging price" is implemented in accordance with DRG charging standards

According to the relevant person in charge of the Quanzhou Medical Insurance Bureau, receivables according to the Diagnosis Related Groups (DRG) are the principles of similarity to hospitalization patients according to the severity of the disease, similar clinical treatment methods, and similar resource consumption. In a group, charge and reimburse according to the corresponding DRG group charging standards, that is, paid at DRG.

The charging standards include diagnosis, treatment, examination, testing, surgery, anesthesia, bed, nursing, medicine and medical consumables during the hospitalization period (except for special separate charging consumables and services), and medical institutions Pay in proportion according to the prescribed proportion.

For example, a medical insurance patient in Quanzhou was hospitalized in the city's third -level hospital. The main diagnosis was "acute appendicitis". The hospitalization was performed as "appendix resection". There was no other complications of complications and was discharged by the treatment effect. According to the patient's diagnosis and treatment plan, it is included in the "appendix resection, none or mild complications complications" group, and it is charged according to the 10050 yuan determined by this group. Among them 70%is 7035 yuan.

There are countless instead of the threshold for medical insurance

Relevant person in charge said that after the implementation of DRG receivables, after the patient's condition and treatment method is determined, they know how much it costs, how much it is, how much it is, how much medical insurance reimbursement, so as to reduce unnecessary examinations, avoid whether to eat or not. The medicine that should be taken to avoid being excessively medical, thereby reducing the medical treatment cost. At the same time, the hospital provided the patient with the category of the hospitalization category and settlement list at the time of discharge, which reflected the medical expenses of the patient's hospitalization, other other charging consumables, special medical services, and clinical blood categories. Clear and clear.

In addition, patients do not affect some special medical needs of patients while implementing the "packaging price" according to the DRG charging standards. They can still choose some medical consumables and medical services, beds exceeding the standards of ordinary ward, etc. These special medical services The hospital is charged in accordance with the original policy, so that under the premise of meeting the normal medical needs of the people, it also takes into account the special needs of a few patients.

According to the original charging model, the medical expenses of the insured person must reach a certain starting threshold, and the medical insurance fund will be paid according to the prescribed proportion. For hospitals that implement DRG paid management, the insured persons incurred according to the cost of DRG charges. Medical insurance is settled according to the group charging standards. Consumption costs are included in the scope of medical insurance payment, and there is no threshold for payment. The cost within the highest payment limit set by the set is shared by the individual and overall funds in proportion, and the part is paid by the patient.

After the reform of DRG and paid, the patient included in DRG's payment management and the corresponding medical insurance consumables were included in the cumulative scope of medical insurance costs, which complied with medical expenses of large medical expenses subsidies, urban and rural residents' serious illness insurance, medical assistance and other policies. Continue to implement in accordance with relevant regulations.

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