China.org.cn | October 11, 2024
National Business Daily:
The third plenary session of the 20th CPC Central Committee proposed supporting coordinated development and management of medical services, medical insurance and pharmaceuticals, as well as further reform of medical insurance payment models. We noticed that the NHSA recently released a new version of the DRG/DIP classification plan. What measures will the administration take to implement these requirements and further enhance its capabilities for pursuing high-quality development? Thank you.
Zhang Ke:
Thank you. I would like to invite Ms. Li to answer this question.
Li Tao:
Thank you for your question. The NHSA has resolutely implemented the decisions and arrangements of the CPC Central Committee and the State Council, and continued to reform medical insurance payment models. In recent years, in terms of hospitalization expenses, we have accelerated the promotion of the DRG/DIP payment methods, which are diversified, compound medical insurance payment models featuring predominantly bundled payments based on disease types and diagnosis-related groups. By the end of 2023, the program had already covered all regions under unified management nationwide, generally bringing changes in four aspects. First, the medical insurance payment model has been switched from treatment-based to ones that are based on disease types and diagnosis-related groups. Second, medical insurance settlement has been switched from post-paid to pre-paid. Third, audit approach has been switched from manual audit to one that is based on the application of big data. Fourth, the provision of medical services has been switched from extensive management to precise management. We have fully implemented management mechanisms such as global budget, evaluation and oversight, as well as allowing medical institutions to keep the surplus of allocated funds and share the overspend. By doing so, we have standardized hospitals' diagnosis and treatment, ensured rational drug use, improved efficiency, and controlled costs, thereby alleviating the overall burden of medical treatment for insured patients, reducing time spent, as well as supporting coordinated development and management of medical services, medical insurance and pharmaceuticals.
Meanwhile, the reform of medical insurance payment models is a phased process in which progress is continuously being made. Recently, we have focused on problems reflected by both medical institutions and the public concerning imprecise classification plans and limited length of hospitalization. We released version 2.0 of the classification plan to further improve the technical standards and supporting policies for medical insurance payments based on disease types and diagnosis-related groups, with priorities on establishing new mechanisms concerning separate discussion for special cases, pre-payment, opinion soliciting and feedback, consultation and negotiation, as well as data working groups. Take separate discussion for special cases as an example. For special cases that involve extended hospitalization, high medical expenses and frequent use of new medicines, medical consumables and technologies, as well as complex, severe and critical symptoms, we have ensured that medical institutions can decide for themselves whether to apply for separate discussions. The medical insurance departments will then review those cases, and consult with medical institutions to adjust the charging standards, so as to better satisfy the demands of clinic treatment and medicine use, as well as relieve the burden of high medical expenses on patients.
Next, the NHSA will be more conscious of pressing concerns of the people, and continue to reform medical insurance payment models. First, we will establish a dynamic adjustment mechanism of DRG/DIP payment, which pays hospitalization expenses based on disease types and diagnosis-related groups. By doing so, we will better satisfy patients and clinical needs, as well as improve payment efficiency of medical insurance funds in a more scientific and precise manner. Second, we will improve the diversified, compound payment system, and explore payment models in line with the characteristics of medical services such as outpatient care and close-knit medical communities. Third, we will strengthen coordination and interplay with the National Health Commission and other relevant departments, as well as support coordinated governance of medical services, medical insurance and pharmaceuticals, so as to effectively protect the people's right to health. Thank you.