According to the website of the National Medical Insurance Administration, the "Obstetrics and Gynecology Medical Service Price Project Approval Guidelines (Trial)" (hereinafter referred to as the "Obstetrics and Gynecology Project Approval Guidelines") have been issued recently. The original obstetrics and Gynecology medical service price items in various regions have been mapped and integrated into 30 items, with appropriate price item granularity, highlighting the value of medical technology and labor services, empowering the stable operation and development of obstetrics and gynecology. At the same time, projects such as "childbirth pain relief", "guided delivery", and "family companionship" have been separated to better adapt to the transformation of fertility concepts, promote the improvement and optimization of fertility services, meet the diversified needs of fertility services, and help build a fertility friendly society. What are the main considerations for standardizing and integrating obstetric pricing projects? The medical service price item is the pricing unit for medical institutions to charge surgical fees, treatment fees, diagnosis and treatment fees, nursing fees, examination fees, and other medical service fees. In terms of image, standardizing and integrating obstetric pricing projects means transforming the relatively distinctive medical service projects in different regions into a unified national standard of Mandarin. In the past, the pricing of medical services was led by pricing departments in various provinces. There were significant differences in the quantity of pricing items among provinces, as well as in the names, connotations, pricing units, and consumables charges of pricing items. Taking difficult delivery as an example, various regions have set up multiple price items such as forceps delivery, hip position delivery, fetal head rotation, and manual placental retrieval based on different situations and methods. In fact, these items have similar technical difficulties, resource consumption, and technical difficulty. However, in clinical practice, difficult delivery situations are more complex and diverse. With the development of medical technology, new delivery methods will gradually be introduced into clinical practice. In the past, the project approval method that closely linked specific operations with price items resulted in price items being too fine and too small, which cannot adapt well to the charging needs of some new technologies and to some extent does not meet the practical needs of technology entering clinical practice quickly. Therefore, it is necessary to further highlight the orientation of service output, categorizing basic items such as resource consumption and technical difficulty into one category. Therefore, the original obstetric price items in various regions have been unified and standardized into 30 items according to appropriate granularity to better adapt to clinical practice. What new demands have been put forward for obstetric pricing items in clinical practice? Based on frontline research, the current demand for obstetric development in clinical practice is mainly reflected in two aspects: firstly, the hope to add new medical service pricing items; Secondly, we hope to better reflect the value of obstetric medical technology and labor services. On the one hand, with the development of medical technology, optimization of population policies, and progress in fertility concepts, many medical institutions have successively launched more humane obstetric medical services in recent years, such as "childbirth analgesia". In practice, some places charge according to the original spinal anesthesia project, and medical institutions reduce their enthusiasm for providing childbirth analgesia due to the lack of independent price items; In some places, due to the limited number of anesthesiologists, they are unable to provide services and cannot effectively meet the needs of such reproductive medical services. Therefore, medical institutions hope to clarify the direction of pricing policies, fully leverage the function of price adjustment resource allocation, guide medical institutions to provide relevant services, and better meet the diversified reproductive service needs such as painless childbirth. On the other hand, for a period of time, public medical institutions have highlighted the public welfare nature of obstetrics, and medical staff have reported that the overall price level of obstetric services is low, and the value of technical labor is not fully reflected. In fact, this is an objective problem left by the traditional cost based pricing model in the past. Obstetrics and gynecology service projects are mainly invested in manpower, and the proportion of equipment investment and other costs is not high. If the logic of cost based pricing is used, the pricing of obstetrics and gynecology service projects is underestimated, and obstetrics is also in a relatively weak position in the internal income and distribution of medical institutions. Taking ordinary natural delivery as an example, the total cost charged by tertiary medical institutions (excluding childbirth analgesia) is mostly about 2000-4000 yuan, of which the core surgical method for delivery is about 600-800 yuan. Some netizens, after experiencing childbirth, also believe that the price is low. In recent years, with the significant decrease in obstetric services, the price contradiction has gradually become prominent. Therefore, it is necessary to appropriately break away from cost pricing thinking and build price items that better reflect the value of technical labor based on service output quality, in order to promote the stable operation and development of obstetrics. How can the Obstetrics and Gynecology Project Guidelines adapt to the diverse medical service needs of postpartum women? According to third-party research, 13% of young women have a fear of pregnancy and childbirth processes. The Obstetrics and Gynecology Project Guidelines have established separate projects for "Labor Pain Relief," "Guided Delivery," and "Family Companion Delivery," with a clear support for medical institutions to provide humanized delivery services centered on mothers, encouraging active implementation of pain relief delivery services, and supporting qualified medical institutions to provide professional accompanied delivery and guided delivery services to pregnant and postpartum women. Among them, guided delivery services originated in the United States, initially using music to help mothers relax. Nowadays, guided delivery services have been continuously enriched, including professional personnel providing pregnant women with guidance and companionship on guided music related knowledge, providing reasonable force and delivery coordination guidance, using non pharmacological methods such as inhalation pain reduction, delivery balls, and lumbar sacral massage to alleviate delivery pain, assist in labor process progress, help mothers give birth smoothly in a relatively comfortable state, reduce childbirth fear, and promote improved production experience. How does the Obstetrics and Gynecology Project Guidelines reflect the labor value of medical personnel? In recent years, the National Medical Insurance Administration has continued to pay attention to the value of medical personnel's labor services, and has comprehensively established a dynamic adjustment mechanism for medical service prices, which has been operating normally. Price adjustments are carried out with ups and downs, and some technical labor projects such as surgery and traditional Chinese medicine have increased by 20% -30%. The price level of inspection and testing projects has continued to decline. In the preparation of the Obstetrics and Gynecology Project Guidelines, we fully respect clinical practice and, according to the opinions of all parties, carry out separate or additional projects for complex situations and operations with high technical labor value and high risk, reflecting differences in technical difficulty. Taking "vaginal delivery" as an example, "vaginal delivery (conventional)" and "vaginal delivery (complex)" are respectively established based on the complexity, and situations such as scar uterus, macrosomia, fetal breech position, and shoulder dystocia with high difficulty and risk of delivery are classified as "vaginal delivery (complex)". At the same time, a unified pricing unit will be established for items such as "fetal heart rate monitoring," "vaginal delivery," and "amniocentesis," which may involve multiple pregnancies. The pricing unit will be clearly defined as "pregnancy/time," and local medical insurance departments will be guided to pay attention to the labor value of obstetric medical personnel at the price item level. How is the Obstetrics and Gynecology Project Guidelines developed? The National Medical Insurance Administration has commissioned a team of experts to carry out research on the standardization and integration of price items. The Obstetrics and Gynecology Project Approval Guidelines have integrated the original price item specifications into 30 items, and the research and demonstration process is also very detailed and in-depth. The National Medical Insurance Administration has organized nearly 20 symposiums, focusing on listening to the opinions and suggestions of large tertiary medical institutions in provinces and cities such as Beijing, Shanghai, Jiangsu, and Zhejiang. After reaching a professional consensus, opinions from relevant departments, local medical insurance bureaus, and medical institutions are sought to ensure the scientific and rational integration of price items. Some basic guiding principles and key focus points not only highlight problem orientation, but also fully implement the spirit requirements of the Pilot Plan for Deepening Medical Service Price Reform. According to the opinions of obstetric experts from various regions, the obstetric project approval guidelines are generally divided into stages according to the pregnancy and childbirth process, that is, projects are established based on specific examinations, treatments, or operations during pregnancy, prenatal, childbirth, and postpartum stages, and are no longer linked to specific technical details. For example, price items are divided into "prenatal routine examination" and "fetal heart rate monitoring" during the prenatal stage, "induction of labor" and "labor process management" during the labor stage, "vaginal delivery (routine)", "vaginal delivery (complex)", "cesarean section (routine)", "cesarean section (complex)" during the production stage, etc. The specific project scientifically integrates projects with consistent service output and equivalent resource consumption in current price projects in various regions, and clarifies the corresponding relationship between technical services and price projects one by one in accordance with the National Medical Service Project Technical Specifications issued by the health department. This can effectively improve the compatibility of price projects with clinical operations, help break away from the traditional path of project approval based on technical details, and promote the clinical transformation of improved and innovative technologies. What is the overall progress of the preparation of the project proposal guidelines for medical service pricing projects? The formulation of project guidelines for medical service pricing is an important part of the systematic project to deepen the reform of medical service pricing. In May 2021, the 19th meeting of the Central Committee for Deepening the Reform approved the "Pilot Plan for Deepening the Reform of Medical Service Prices", which proposed to standardize the management of medical service price items, make medical service price items better priced, executed, and evaluated, and better adapt to clinical diagnosis, treatment, and price management needs. The National Medical Insurance Administration is organizing experts from various disciplines in an orderly manner to systematically carry out the standardization and integration of national medical service pricing projects, and to formulate project approval guidelines. According to the mature work rhythm of releasing batches, seven price project approval guidelines have been successively released in the early stage, including "Organ Transplantation", "Clinical Scale Evaluation", "Traditional Chinese Medicine (Moxibustion, Cupping, Tuina)", "Traditional Chinese Medicine External Treatment", "Oral Implantation", "Assisted Reproduction", and "Traditional Chinese Medicine Acupuncture". The Obstetrics and Gynecology project approval guidelines have been prioritized as the eighth batch to respond to disciplinary appeals and meet the needs of the public. Next, we will accelerate the progress of preparing and issuing project guidelines for medical service pricing projects, gradually introduce project guidelines for nursing and other categories, and quickly form project guidelines that cover most disciplines. At the same time, the National Medical Insurance Administration resolutely implements the central government's decision and deployment on optimizing fertility policies to promote long-term balanced population development, actively fulfills relevant functions, and continues to make efforts in supporting fertility. It will guide local governments to accelerate the implementation of guidelines for obstetric project approval, reasonably determine the price level of new obstetric projects, better reflect the value of obstetric medical technology and labor services, promote the improvement of the quality and level of obstetric services to the people, and help establish a fertility friendly society. (Lai Xin She)