According to the statistics of China Securities Journal, following the three-year action plan for DRG / Dip payment reform issued by the National Medical Security Bureau, Anhui, Qinghai, Inner Mongolia, Hunan, Jiangxi, Gansu and other places have issued three-year action plans / implementation plans for medical insurance payment reform.
With the spring breeze of reform, listed companies have increased their layout. China Reform Health Management And Services Group Co.Ltd(000503) successively announce the winning DRG / dip information system project; Most of the DRG / Dip projects undertaken by Sichuan Jiuyuan Yinhai Software Co.Ltd(002777) in Sichuan, Yunnan and Zhejiang have passed the acceptance and entered the actual payment settlement; Thalys Medical Technology Group Corporation(603716) announced that it has undertaken the information construction of 4 national platforms and 12 provincial / sub provincial platforms.
medical insurance payment reform enters deep water
On January 6, Anhui Medical Security Bureau issued the three-year action plan for DRG / Dip payment reform in Anhui Province, proposing that 17 overall planning areas in the province should comprehensively carry out DRG / Dip payment reform by the end of 2022 to achieve full coverage of overall planning areas; By the end of 2023, all coordinated areas will basically realize the full coverage of qualified medical institutions, diseases and medical insurance funds; By the end of 2024, a new unified medical insurance payment mechanism across the province will be basically established. New medical insurance companies in Bozhou, Chizhou and other provinces will be added to carry out pilot work. Simulated payment will be started by the end of 2022 and actual payment will be realized by the end of June 2023.
On January 6, Nanjing Medical Insurance Bureau issued an announcement to officially implement the reform of DRG payment mode and publish the list of 36 disease groups, including esophagitis and gastroenteritis; Colonoscopy treatment group; Diabetes mellitus, with complications or complications. Nanjing became the first city in China to use version 1.1 of chs-drg grouping scheme and took the lead in using TCM grouping. In addition, Nanjing Medical Insurance Bureau has developed a medical insurance high-speed railway DRG zone, which dynamically displays more than 120 DRG operation index parameters according to different dimensions such as management level, organization level and time span, and presents the operation efficiency and quality of Nanjing DRG in an all-weather, multi-dimensional, multi-level and refined manner.
It is understood that DRG is to pay by grouping related to disease diagnosis. It is to divide patients into diagnosis related groups with similar clinical diseases and resource consumption according to the patient's disease type, disease severity, treatment methods and other factors, and package the group as a unit to determine the payment standard of medical insurance. Dip refers to paying by disease score. It uses big data to take the disease as the payment unit according to the combination of "disease diagnosis + treatment mode". The medical insurance department determines the payment standard of each disease according to the total amount of medical insurance fund payable every year. The basic principle of forming dip disease score is that the more serious the disease, the greater the difficulty and the more consumption, the higher the resource consumption and the higher the score.
Insiders said that DRG is based on clinical practice, and dip is based on historical data for payment management. The former is widely implemented in the world, but it involves grouping, with high basic conditions and professional requirements. In view of the backward management of medical records and coding in some central and western regions of China, the international payment model cannot be copied. At present, among the 101 pilot cities announced by the national medical insurance bureau to carry out payment mode reform, dip has 71 pilot cities and DRG has 30 pilot cities.
listed companies actively participate in
On January 10, Thalys Medical Technology Group Corporation(603716) said on the interactive platform that Jindou data, which the company participated in, currently occupies a leading position in the DRG / Dip pilot city market, and the number of successful pilot cities ranks among the top. At present, it has undertaken the information construction of 4 national platforms, 12 provincial / sub provincial platforms and nearly 40 Prefecture and municipal platforms such as Sanming and Shenzhen.
On the same day, China Reform Health Management And Services Group Co.Ltd(000503) announced the announcement on WeChat official account. The company won the bid "Shenzhen Medical Insurance Bureau medical service management professional technical service project", providing DRG and DIP double mode full stack service such as quality control of medical insurance settlement list, localization grouping scheme, payment standard calculation, medical organization operation monitoring and macro decision analysis.
According to the data of Shenzhen municipal government procurement supervision network, China Reform Health Management And Services Group Co.Ltd(000503) won the bid at 1.6 million yuan, lower than 2.09 million yuan in the second place Sichuan Jiuyuan Yinhai Software Co.Ltd(002777) . Previously, China Reform Health Management And Services Group Co.Ltd(000503) won the bid of "Ganzi pay by disease score (DIP) information system construction service procurement project". According to the Sichuan provincial government procurement network, the transaction price is RMB 3.3218 million. It is agreed that the dip platform will be completed before June 30, 2022 and officially put into operation on October 1, 2022, taking the lead in bringing the designated medical institutions at the state level into the disease score payment.
In addition to the overweight layout in medical insurance, many listed companies said that they also provided a series of DRG / Dip solutions for hospitals. Dhc Software Co.Ltd(002065) said that the company has launched hospital-side DRG / Dip products in more than 200 hospitals. Sichuan Jiuyuan Yinhai Software Co.Ltd(002777) said that the company has completed the implementation and application of hospital-side DRG / dip in nearly 100 hospitals and multiple medical communities in 10 provinces. At present, most of the DRG / Dip projects undertaken in Sichuan, Yunnan and Zhejiang have passed the acceptance and entered the actual payment settlement.
Minsheng Securities believes that DRG / dip, as a new digital and systematic payment method, can improve the overall efficiency of the system and realize the win-win of hospitals, medical insurance and patients on the premise of saving resources. In terms of medical insurance bureau, the medical IT construction is in full swing, and the overall planning areas are quickly covered by provincial units. The hospital has sufficient power to promote DRG / Dip construction due to the needs of industrial policies, cost control and performance appraisal. It is estimated that the hospital will bring 19.216 billion yuan of market space.
the problem of difficult profit remains to be solved
China Securities Journal reporter observed that although listed companies have sufficient momentum to overweight, they still face the problem of difficult profitability.
On January 10, Thalys Medical Technology Group Corporation(603716) announced that the company is committed to providing medical institutions with a smart hospital lean management service scheme integrating SPD + CDSS (clinical auxiliary decision-making system) + DRGs / Dip medical insurance fee control service. However, the business transformation still needs investment and development cycle. The SPD business as a whole is still in the construction stage. At this stage, the overall gross profit margin is about 10%, which is lower than the gross profit margin level of the original IVD business. There is a risk that the overall gross profit margin of the company will decline.
China Reform Health Management And Services Group Co.Ltd(000503) said in an institutional survey that the overall gross profit margin of China Reform Health Management And Services Group Co.Ltd(000503) digital medical insurance business in 2020 is negative, mainly because the project has a high degree of customization, which usually involves complex problems in medicine, pharmacy, statistics and other fields, which need to be solved by professionals in relevant aspects, and the labor cost is high. It is estimated that by the end of 2022, the company's digital medical insurance revenue can not cover the total cost.
