Medical Insurance Payment Method Reform to Focus on Clinical Needs and Protect Participants’ Rights
In response to concerns about the reform of medical insurance payment methods, the National Medical Insurance Administration has clarified the purpose and impact of the changes. According to People’s Daily reporter Sun Xiuyan, the reform aims to guide medical institutions to focus on clinical needs and ensure proper diagnosis and treatment practices, rather than simply controlling expenses.
The reform includes the introduction of new payment methods such as DRG (disease group) and DIP (disease score) in order to reduce project-based payments and encourage appropriate use of technology in diagnosis and treatment. The payment standards will also be adjusted in accordance with social and economic development, ensuring the growth of medical insurance fund expenditures.
Furthermore, the National Medical Insurance Administration has dispelled rumors of restrictive regulations such as “a single hospitalization shall not exceed 15 days.” Any instances of such regulations are the result of mismanagement by individual medical institutions and are not endorsed by the national department. In fact, the administration has issued a notice to investigate and eliminate any unreasonable restrictions on medical insurance.
Regarding concerns about the use of new equipment and high-priced drugs under the payment-by-disease model, the administration has implemented rules to support the application of new technologies and ensure adequate treatment for seriously ill patients. Eligible new drugs and technologies are excluded from the standard payment, and special negotiation rules are in place for severe cases with high costs.
Recognizing the complexity of medical issues and the rapid advancements in technology, the National Medical Insurance Administration is committed to collecting feedback from medical institutions and personnel to continuously adjust and improve the grouping rules. This dynamic approach will ensure the scientificity and rationality of the medical insurance payment method and address any discrepancies between policy and practice in the field of medical care.