This year, the Ministry of Human Resources and Social Security has been brewing in the health care payment mechanisms in more action, and in the outpatient service and capitation payment system is activated, the total payment mechanisms in place to implement once meet resistance. Recently, the Ministry of People s Insurance Health Insurance Secretary, Yao said: "At present, the document issued, many places do not know how to do. Capitation payment total should explore ways to explore the direction is more to the hospital medication autonomy. "
This reporter has learned that China s current health insurance fund is facing the pressure of rising medical costs. According to statistics, China s per capita health expenditure growth of 14%. This time, the Ministry of People s Insurance medical institutions and health care departments want to be able to do risk quintals.
In order to enhance the enthusiasm of medical institutions, the People s Insurance Department will carry out exploration by DRGs, plans to give hospitals more autonomy, the specific course of treatment, the hospital can have more right to the drug of choice.
To achieve this goal, the People s Insurance Department will also reform the management of health insurance directory, Yao said: "The future of drug A and Medicare B directory to gradually eliminate the difference, directory management audit will also change, to quality control to gradually direction of development. "
Annual cost settlement
Total amount of prepaid health care system is Medicare departments of medical institutions in the assessment, to calculate the per capita health care costs, costs of the standard here fixed to the hospital pre-paid medical expenses, if the actual cost overruns, cost overruns in part by the hospitals themselves.
At present, most areas have adopted pay-for-service payment. Than the current Medicare payment, the total pre-paid system to enhance control of medical practices, can effectively improve the health care institution to open a large prescription, chaos checks, arbitrary charges, any expansion of services and other defects.
According to Reporters learned that Shanghai has been the pilot of the total amount paid by the mechanism, health insurance departments are organized every year on the 1-year hospital Medicare to negotiate with the hospital total costs, this amount paid on an annual basis negotiations have been in containing health care expenses rapid growth has played a role.
Yao said: "In the past health care sector is concerned about the budget and settlement of revenue management, is to focus on strengthening expenditure budget management, group management, the various groups need to calculate the settlement amount of expenditure and how much different hospitals and expenditure budget What is the amount. "
For this reason, people carry out in co-ordinating the Department made a "how much money to do many things" concept. According to Yao introduction: "I basically made the calculations, according to these hospitals to calculate the tax-free high-tech enterprises, commercial drugs counted as income tax, business is good."
The health care sector is now facing pressure than in large medical institutions, due to rising medical costs, the threshold current deductibles and payment lines have no control over pay increases.
Total prepaid system, however there are some problems, the total pre-paid method is usually to pay for health care institutions a year total, in this case, the hospital is the biggest risk.
Medical institutions and doctors in order to improve the enthusiasm of the People s Insurance Department plans to phase out the use of medical management and the right medicine to the hospital.
The right medication to be delegated
About how to assess the value of medical services, Yao said: "Medicare should pay for health economics from the perspective of input and output, health insurance departments should also strengthen the research in this area."
In recent years, with investment in improved health care and medical institutions in support of the policy, after years of expansion of development, China s medical institutions, health care quality has also improved, but, once the hospital s total control of a charge in the cost fixed case, how to ensure quality of care? This is a problem faced by medical institutions, but also the challenges facing drug development companies.
According to Yao introduction: "The future medical treatment for full liberalization of the right, according to the DRGs of the pilot hospitals, the patient medication will no longer points A and B drugs, drug use entirely by the hospital to decide how to evaluate hospital , on how to use drugs. "
In addition, the choice of drugs in the directory, the People s Insurance Department has new ideas. Yao said: "The meaning and management of drug prices to adjust the starting point, what is the price of the drug purchase, should cure the patient as a starting point, to consider the economic value of pharmaceutical drugs."
Social Security Medicare national human researcher Dong Zhaohui said: "A new drug program is not cost-effective, we should pay for the new treatment program cost? If this treatment be integrated into the health insurance reimbursement directory, how to be drug list? Last , from the perspective of equity and efficiency, what treatment should be encouraged to limit what treatment options? these issues will be fairness in the assessment and evaluation of the budget in the affirmative. "