The small disease went straight to the big hospital, and the reimbursement was down 15%
Shandong Commercial Daily
the public expectations, such as "Two-way Referral" and "classification according to the disease type", have been returned to the provinces and cities. In recent years, the implementation plan of the Ji'nan grading diagnosis and treatment work (hereinafter referred to as "the" program ") has given the solution path and timetable, and the classification diagnosis and treatment will be fully started by the end of May 2016. It is estimated that before the end of 2020, Ji'nan will basically form a hierarchical diagnosis and treatment mode of "first level consultation at the grass-roots level, two-way referral, quick and slow treatment and up and down linkage". Among them, in the future, patients will see a minor illness and go to a large hospital directly, and medical insurance reimbursement will be reduced by 15%. The reporter Liang Geng "big hospital" focuses on the whole classification diagnosis and treatment system of difficult and complicated diseases. The province (Department) belongs to the three level hospital and the three level hospital of the troops of the Jiji is mainly provided with "diagnosis and treatment service of critical and difficult and complicated diseases, gradually reducing general out-patient and common medical service."
as an example of "level two hospital", it is clearly "provided the common diseases and multiple disease diagnosis and treatment services within the jurisdiction, receiving the acute disease, the postoperative recovery period and the stable period of the critical illness in the three level hospital, and the corresponding medical service in the first level hospital, the community health service center (station) and the township health center." In the case of function, the two grade hospital should undertake its medical service function. The plan also proposes that there will be various forms of medical consortium. There are mainly three forms of medical consortium.
one is to form a comprehensive medical Union through collaboration. In the city, in principle, the area of the administrative area, according to the three level hospital, two level hospital, first level hospital (or community health service center) to form a comprehensive medical Union. The second is to play a specialist advantage to form a specialized medical association. In addition, public medical institutions will pair up to help private medical institutions. According to the plan, Ji'nan will strive to achieve full coverage of medical consortium in the whole city by 2017. Ji'nan will open the two-way referral channel, not included in the above construction system, every township health center, community health service center (station), according to its own situation and geographical location at least 2 more than two level hospitals sign two-way referral agreement. When referral, the patient must receive the consent of the patient and fully respect the independent choice, according to the near, the ability, the principle of referral on demand, the implementation of the referral system, the implementation of the referral procedure. The plan for reimbursement of the major hospital without referral to the 15% "plan" is clear, Ji'nan will focus on ensuring large and large diseases, moderate control of general disease compensation costs, to meet the basic medical needs of the masses. The proportion of hospitalization expenses in the range of medical insurance and medical insurance policy of the workers and workers should be over 75% and 70% respectively, gradually narrowing the gap between the payment ratio of the actual hospitalization expenses.
adjust the medical insurance differential payment policy of different levels of medical and health organizations in time according to the requirements of grading diagnosis and treatment, and appropriately increase the proportion of medical insurance payment in medical and health institutions at the grass-roots level. The difference of reimbursement ratio between different levels of medical and health institutions is not less than 10%. In accordance with the provisions of the referral, the hospitalized patients can calculate the starting and payment line continuously. The insured patients without referral should be calculated separately, and the payment ratio of the medical insurance fund in the hospital should be reduced to 15% in order to guide the masses to see the medical treatment in the medical and health institutions at the grass-roots level.
2016, we strive to pay more than 30% of discharged patients in public hospitals at county level or above. By 2017, a combined payment system based on payment by disease and paid by people and paid by service units has been basically implemented.