In order to further promote the reform of Guangxi's medical service pricing methods and reduce the burden on patients, the Autonomous Region Price Bureau and the Autonomous Region Health Planning Commission and the Human Resources and Social Security Bureau jointly issued a notice to further promote Guangxi's collection and payment work.
What is the impact of this policy on the payment of diseases by patients? What is the difference between the previous single-income payment policy? In response to the concerns of these citizens, the reporter interviewed the relevant person in charge of the Autonomous Region Price Bureau and answered questions for everyone.
Established a fee-paying standard for 127 diseases
What is the difference between the policy of paying for the disease and the previous single-income payment policy?
The relevant person in charge of the Autonomous Region Price Bureau explained that the number of diseases implemented was different. The previous policy only set the charging standard for 52 diseases. This policy has set a fee-paying standard for 127 diseases. Second, the scope of implementation is different. The previous policy was a pilot and was implemented only in some public medical institutions; the policy introduced this time was implemented in public medical institutions at the second and third levels in the whole district. Third, the payment policy is different. Prior to the policy, the sickness charge and the medical insurance payment were separate and unsynchronized; the policy collection and payment standards issued this time were simultaneously formulated and simultaneously included in the scope of medical insurance payment.
The hospitalization expenses are covered, and the excess is borne by the public medical institution.
Will the policy of paying for diseases according to the disease will increase the burden on patients?
The person in charge said that by implementing the disease-based treatment and the treatment management process according to the disease, the standardized diagnosis and treatment of patients can effectively prevent the occurrence of over-examination, over-treatment and over-medication, and control the unreasonable rise in medical expenses and reduce Patient burden.
At the same time, the policy according to the disease collection and payment clearly stipulates that the sickness fee standard includes all the costs of diagnosis and treatment during the hospitalization of the patient, that is, the patient is admitted to the hospital, and the standard treatment is adopted according to the treatment management process of the disease, and finally meets the clinical efficacy standard. Discharge, discharge, treatment, surgery, anesthesia, care, bed, medicine and medical consumables incurred throughout the process. The hospital charges according to this standard, and the medical insurance fund and the insured patients pay according to the prescribed proportion. In addition to the blood transfusion costs (including blood costs), the patient's discharge from the hospital, and the bed fee for the patient's inpatient ward exceeding the standard for the standard bed rate, the hospital may not charge another fee.
In addition, in terms of medical insurance payment, the insured patient is diagnosed and admitted to the hospital, and after signing the payment-based medical treatment agreement, the medical insurance pays the prescribed fee in a lump sum according to the disease standard, and is used by the public medical institution. If the expenses of various medical treatments during the hospitalization period do not require the patient to pay in addition, the public medical institution shall bear the expenses.
Proposed development of clinical pathway management rules for disease-based charges
Is there a charge for sickness, and can medical institutions charge other fees than the standard for sickness? After the patient chooses to pay for the disease, can he still change the project fee?
According to the disease charge standard, all the expenses such as diagnosis and treatment during the hospitalization period of the patient are included, that is, the patient is admitted to the hospital, and the standardized treatment is accepted according to the treatment management process of the disease, and finally the clinical efficacy standard is discharged, and the diagnosis, treatment, and the whole process occur. Surgery, anesthesia, inspection, care, and bed, medicine, medical supplies and other costs. Medical institutions charge according to this standard, and medical insurance funds and insured patients pay according to the prescribed proportion. In addition to the blood transfusion costs (including blood costs), the patient's discharge from the hospital, and the bed fee for the patient's inpatient ward exceeding the standard for the standard bed rate, the hospital may not charge another fee.
After the patient chooses to pay according to the disease, if there are complications, complications, etc. during the treatment, the clinical route can be withdrawn according to the following regulations: the patient who participates in the basic medical insurance, the person (or family member) agrees, and the social insurance After the approval of the agency, the clinical pathway will be withdrawn, and the cost of diagnosis and treatment will be calculated separately; the self-paying patients will be implemented according to the relevant provisions of the national clinical pathway management. Patients who withdraw from the clinical pathway as prescribed can be converted to a fee for medical services.
In addition, the new policy is mainly implemented in Guangxi's second- and third-level public medical institutions. "Guangxi's current medical service price policy stipulates that medical services provided by non-public medical institutions shall be subject to market-adjusted price management, and shall be independently priced by non-public medical institutions. If non-public medical institutions are willing, they may voluntarily refer to them on their own initiative, provided that they are willing." The person in charge said.
According to reports, the health and family planning department of the autonomous region will also work with relevant departments to formulate clinical route management rules for disease-based charges to ensure that medical institutions do not reduce the quality of medical services after they are charged according to the disease. The price, health and family planning, and human and social departments at all levels will also strengthen supervision and inspection of medical service behaviors of medical institutions. The implementation of these measures will help ensure that patients choose the quality of medical services they receive on a case-by-case basis. (Reporter Wei Jing)
(Source: Nanning Daily)
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