The 2016 health examination | Medicare payment reform of Sohu – dynamic picture of health
the 2016 Medicare payment reform raging like a storm. In addition to the total prepaid amount, according to the reform of DRGs, capitation, bed or single or composite payment, also around the plough, up to understand it! Source: health sector Author: Ma Lin
in 2017 stood at the starting point, review the 2016 domestic medical and health system reform from the money ring, the recent Medicare payment reform, only a feeling: raging like a storm.
Although the total prepaid amount is
the number of complaints of medical institutions, but now its mainstream status is still unshakable. At the same time, the reform of DRGs, per diem payment, capitation and other methods is the combination of payment, has been put in more and more local reformers and the desk, or deep or shallow exploration. The overall trend is that the medical insurance regulatory services to medical institutions gradually extended to the medical staff of medical service behavior regulation.
April 28, 2016, human resources and social security Yan Qinghui, deputy director of the Department of medical insurance department revealed a group of "Outline" data: as of April 2016, 85% of the overall area of our country carried out to pay the total control; more than 70% of the whole area to carry out DRGs; 35% of the overall area of the service unit, mainly by the bed pay day; 24% of the overall area is carried out according to the exploration of capitation.
total prepaid throughout the country
representative area: Jiangsu
called the "total amount of prepaid", according to the designated medical institutions within a certain period of time, the total annual number of admissions, admissions are cost level of overall compensation control the total amount of the annual medical agencies, regularly set aside, to implement the total control, overspend share payment.
as mentioned earlier, the total amount of medical insurance is currently the most extensive coverage of a medical insurance payment. It as a means of management, in 2016 when the specific programs in different regions are not consistent.
in Jiangsu Province as an example. In 2016, Jiangsu Province, the full implementation of the total prepaid amount, the total control in most areas, and the provincial capital of Nanjing city chose relatively more sophisticated payment management, in the framework of the total advance of reference both times the cost, visitors head than other indicators, at the end of the year according to the actual service number was adjusted, the pursuit of fine pay the.
practice shows that the total amount of prepaid can be described as a double-edged sword". The benefit is the medical institutions to control the cost, ease the unreasonable growth of medical expenses incentives; also led to negative effects, such as many hospitals use prevarication patients, decomposition hospitalization, improve patient pays the proportion, game and medical insurance management department. And this kind of game, patients and doctors have become victims