Recently, the National Medical Insurance Administration issued the notice on the connection of DRG / Dip function modules in the payment mode management subsystem (hereinafter referred to as the “notice”), which made it clear that DRG / Dip function modules will be applied nationwide by the end of November. Accelerate the in-depth development of DRG / Dip reform and implement the three-year action plan for DRG / Dip payment reform (hereinafter referred to as the “plan”).
DRG / Dip will be implemented nationwide by the end of November, and the reform of medical insurance payment will be accelerated. In November 2021, the National Medical Insurance Administration issued the plan, which made it clear that DRG / Dip reform would be carried out in no less than 40% of the regions by 2022. By the end of 2024, DRG / Dip payment reform would be carried out in all overall planning regions across the country. By the end of 2025, DRG / Dip payment would cover all qualified medical institutions providing inpatient services, and basically achieve full coverage of diseases and medical insurance funds. Subsequently, the notice made clear the work plan of each stage in 2022: select some provincial medical insurance platforms for testing from April, select some new areas for pilot use of the DRG / Dip function module of the national unified medical insurance information platform by June, and realize the national application by November. The notice further defines the “three steps” of China’s medical insurance payment reform in 2022, and the goal of the year is far higher than the construction goal of 2022 proposed in the plan, indicating that China’s DRG / Dip reform has accelerated and the industry is expected to accelerate significantly.
It is clearly required to apply the national unified DRG / Dip module, so that the 10 billion market space can be seen. Notice
It is clearly pointed out that all regions must use the DRG / Dip function module provided by the national unified medical insurance information platform, which means that the standardized DRG / Dip module has become a necessary project for Chinese medical institutions.
Medical insurance bureaus and medical institutions in various provinces and cities have corresponding demands for information construction such as medical insurance information platform and system interface, and the market scale has clear growth space. According to China’s construction objectives, the new market scale of DRG system in 2024 is about 12.3 billion yuan. At the same time, local medical insurance bureaus accelerated the bidding of information platform projects, and the medical insurance information market was opened accordingly.
The DRG pilot in many places has achieved remarkable results, and the quality payment is expected to be fully launched. Since 2019, the national medical insurance administration has launched DRG payment pilot projects in 30 cities and dip payment pilot projects in 71 cities. In the three years since the pilot, all pilot cities have entered the actual payment, with remarkable results:
(1) gradually standardize clinical behavior. According to the National Medical Insurance Bureau, in 2021, the average proportion of drugs in medical institutions in Beijing decreased by 14.6pct to 24.2% year-on-year, and the proportion of medical service expenses increased by 5.4pct to 36% year-on-year.
(2) DRG can effectively reduce the burden of insured personnel. According to the National Medical Insurance Bureau, in the ten years since the application of DRG in Beijing, on the premise that the consumer price index has increased by 28.4% in the ten years, the cost per weight of hospitalization has increased by only 17.8%, and the personal burden of insured personnel has decreased from 33% to 28%.
(3) realization of clinical value. DRG diagnosis group payment effectively standardizes medical behavior and eliminates falsely high costs. According to the survey of the National Medical Insurance Bureau, after a hospital in Beijing paid for DRG implantation in 2021, the average cost of disease group decreased by 42.2%, the hospitalization period shortened significantly, and the number of surgical cases increased by 20% year-on-year. The hospital lost 120 million yuan in 2020 to a surplus of 340 million yuan in 2021.
On the one hand, based on the results feedback of the pilot, the National Medical Insurance Bureau has continuously updated and optimized the DRG payment scheme. On the other hand, many local medical insurance bureaus issued the national medical security plan to actively promote local DRG / Dip reform. In the future, DRG / Dip payment reform is expected to accelerate nationwide and fully realize quality payment.
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Risk warning: the policy is not as expected; Budget adjustment.
