According to the National Medical Insurance Administration on December 19th, in the process of promoting the reform of medical insurance payment methods such as DRG payment based on disease diagnosis, many regions are exploring and supporting the development of new medical technologies and the treatment of difficult and severe cases. DRG payment refers to the formation of different diagnostic related groups based on disease diagnosis, treatment methods, and individual patient characteristics, and each diagnostic related group determines a unified payment standard. Compared with traditional payment methods, DRG payment is a more scientific and refined medical insurance payment model, which uses big data methods to group disease diagnosis and treatment, package payment, and avoid problems such as "large prescriptions" and excessive diagnosis and treatment. According to the previously issued "Technical Specifications for DRG Grouping and Payment of National Medical Security" and other relevant documents, for new technology projects that have been registered in medical insurance, payment can be temporarily executed according to the project for one year, and then the payment standards for the disease grouping can be revised based on data calculation; For special situations where the length of hospital stay is too long or the cost of hospitalization is too high, as well as other situations where payment by project can be applied for with the approval of the medical insurance agency, special application for payment by project settlement can be made. In the treatment of difficult and severe cases, it is clear that the weight value of the difficult and severe DRG group can be increased, while the weight value of the mild DRG group can be reduced. Some local medical insurance departments are exploring the establishment of DRG payment support mechanisms for new medical technologies in pilot work. For example, Handan, Hebei Province has clarified that disease groups with abnormally high and abnormally low values can be paid according to the project, and a list of special treatments, special medications, and high-value consumables can be included in the DRG group to ensure full coverage; Zhejiang, Henan, Guangxi, Guizhou and other provinces will increase the weight of key disciplinary disease groups, appropriately reduce the weight of basic or common disease groups, guide tertiary medical institutions to focus on treating difficult and complex diseases, and improve the efficiency of medical resource allocation. At present, most provinces have generally established a special case negotiation mechanism. For special cases with particularly complex conditions, high costs, or objections to grouping results, expert evaluation is conducted. Those who meet the conditions can be paid based on the actual situation. (Reporter Peng Yunjia) (Liao Xinshe)
Edit：GuoGuo Responsible editor：FangZhiYou
Source：people.cn
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