150 kinds of diseases or "package" fees, Ji'nan carries out multiple combination medical insurance payment methods.
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recently, the General Office of the Municipal Government issued the "Jinan Further Deepening the Reform of the Basic Medical Insurance Payment Scheme". It is understood that Ji'nan will implement a multiple combination of medical insurance payment. In terms of payment by disease, daytime surgery and qualified outpatient treatment of diseases of Chinese and Western medicine will be gradually included in the scope of payment by disease. By the end of the year, there will be 150 kinds of payment by disease. < br /> < br /> Focus 1: Fully implement the multi-component medical insurance payment mode < br /> < br /> According to the above implementation plan, Jinan will further strengthen and improve the budget management of the medical insurance fund, and comprehensively implement the multi-component medical insurance payment mode under the total budget management. By the end of 2020, we will establish and improve a multi-component and composite medical insurance payment system that meets the needs of different diseases, different service characteristics, both incentives and constraints, and form a medical insurance payment system that conforms to the actual situation of our city and the characteristics of medical services. In the aspect of improving the key guarantee mechanism, the above-mentioned implementation plan explicitly proposes that the large medical fees for critical illnesses should be separately settled, not included in the total control index of the medical insurance fund, and medical institutions should be encouraged to actively treat critical patients.
focus 2: what are the multiple compound medical insurance payment methods? In the above-mentioned implementation scheme, < br /> < br /> < br /> payment by disease type < br /> < br /> payment by disease type will be implemented for diseases with clear diagnosis and treatment scheme and discharge standard and mature diagnosis and treatment technology. Based on the past expense data and the payment ability of the medical insurance fund, the payment standard of diseases is scientifically determined, and the proportion of medical insurance fund and individual share is reasonably determined. Day-time surgery and qualified outpatient treatment of diseases of traditional Chinese and Western medicine will be included in the scope of payment according to the type of disease, guide the use of appropriate technology, save medical costs. By the end of 2018, there will be 150 kinds of payment by disease. According to the above-mentioned implementation plan, < br /> < br /> by bed day, by head < br /> < br /> by bed day payment can be adopted for diseases requiring long-term hospitalization, such as psychosis, tranquil care, medical rehabilitation and so on. In terms of payment by head (or per head) quota, fees for grass-roots medical services, prescribed outpatient diseases and general outpatient services, as well as hospitalization fees that cannot be paid by type of disease or bed day, will be paid by head (or per head) quota on the basis of total control. [br /> < br /> will explore the way to pay for disease diagnosis-related grouping (DRGs) < br /> < br /> research explore disease grouping according to disease severity, treatment complexity and actual resource consumption level, disease diagnosis-related grouping for medical insurance payment. In accordance with the unified plan of the state and the province, the payment method should be synchronized with the provincial health insurance. Br < br /> < br /> will explore the payment method < br /> < br /> which accords with the characteristics of traditional Chinese medicine service, and bring the hospital preparations of traditional Chinese medicine into the payment scope of medical insurance according to regulations. Outpatient use of Chinese herbal medicine and Chinese medicine appropriate technology, medical insurance according to the provisions to a certain proportion of reimbursement. In addition, the medical community should support the implementation of the medical insurance payment policy of total payment, fund balance retention and reasonable overexpenditure sharing. We will push forward the mutual recognition of medical examination and medical imaging examination results among medical institutions at the same level and within the medical community, and realize the sharing of laboratory examination resources.