The Ministry of Human Resources and Social Security recently announced the recommended list of medical insurance-based disease-paid diseases, and 130 diseases were included in the catalogue. According to the requirements, all localities should determine not less than 100 diseases to be paid according to the disease type. The Ministry of Human Resources and Social Security emphasized that the control of unreasonable medical expenses will increase and the burden of personal expenses will not increase.
The so-called payment by disease means that the fixed disease payment standard for each disease is scientifically formulated through a unified disease diagnosis classification. The social security institution pays the hospitalization expenses to the designated medical institution according to the standard and the number of hospitalizations, so that the medical resource utilization is standardized. That is, the resource consumption of medical institutions is directly proportional to the number of inpatients treated, the complexity of the disease, and the intensity of service. In short, it is to stipulate how much money a certain disease should cost, thus avoiding the abuse of medical service projects, repetitive projects and decomposition projects by medical units, preventing hospitals from becoming ill and ensuring the quality of medical services.
A total of 130 diseases in the recommended list published by the Ministry of Human Resources and Social Security include acute myocardial infarction, cataract, tuberculosis, herpes zoster, and esophageal malignancies. Most of them are for surgical treatment, and only a few are non-surgical treatments, such as childhood acute lymphoblastic leukemia (ALL), the treatment is induced remission chemotherapy (initialized patients); there are several treatments for the disease. It is a Chinese medicine treatment.
The Ministry of Human Resources and Social Affairs requires that all localities should choose to pay for diseases according to the diagnosis and treatment plan and the criteria for clear admission and admission, mature diagnosis and treatment techniques, stable clinical path, and little difference in comprehensive service costs. According to the international disease classification, surgery and operation coding system, the specific diseases are determined, and the hospitalized surgical diseases and some simple treatment items are mainly used. The day surgery and the qualified outpatient treatment of Chinese and Western medicines are gradually included in the medical insurance fund diseases. The scope of payment. When determining the paid disease type, adhere to the expert argumentation mechanism, organize experts to demonstrate the name of the disease and the main treatment methods, ensure that the clinical use norms are effective, and the standard formulation is scientific and reasonable.
The Ministry of Human and Social Affairs pointed out that the "Medical Insurance Paid Diseases Catalogue" is a recommended catalogue for the payment of disease-based diseases in various places, mainly providing disease selection for various places. On this basis, all localities can reasonably determine the scope of medical insurance payment according to the actual situation of medical insurance management and medical technology development, but it should be determined that no less than 100 diseases should be paid according to the disease type.
According to the regulations, when determining the payment standard according to the disease type, the local government should fully consider the medical service cost, the actual actual expenses, the medical insurance fund tolerance and the burden of the insured personnel, and the main operations and treatment methods of the disease, and the medical institutions. Negotiation and negotiation are reasonably determined. It is necessary to strengthen the management of medical expenses paid for by disease, monitor and analyze the personal burden of the insured, avoid the cost transfer, and increase the personal burden. (Beijing Youth Daily)
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