Research On DRG Payment System Of Basic Medical Insurance For Units Directly Managed By S Province’s Governments

Medical insurance is established in accordance with the provisions of the "Social Insurance Law" of the country.It is one of the most important and basic social insurances for the country and society.It plays a pivotal role in social development and people’s livelihood protection,and is related to the smooth operation of society and the people,The quality of life and the economic burden of society and individuals.As the foundation of social development,medical treatment has gradually appeared in recent years that expenses have grown too fast and people are overburdened.The role of medical insurance payment methods in promoting the healthy development of social medical treatment has also been paid attention to.The reform of the medical insurance payment method has always been a key task of the medical reform,and the DRG payment system is the most scientific and cutting-edge payment system that has been widely praised around the world.The DRG payment system is an important means to solve the problems of medical expenses and medical quality.Studying the DRG payment system of basic medical insurance for units directly managed by S Province’s governments will help to further deepen the understanding of the nature of the DRG payment system,and is of great significance for improving the management level of medical insurance fund payment and preventing medical insurance fund risks.Not only can it improve the quality of hospital medical services and better protect the medical rights and interests of insured patients,it also helps to effectively save medical insurance funds and promote the healthy development of medical insurance.From the perspective of the medical insurance department,this article sorts out the development and operation process of the DRG payment system of basic medical insurance for units directly managed by S Province’s governments,discusses the implementation effect of DRG payment,considers the potential risks of DRG payment,and puts forward preventive suggestions for existing risks.This article is mainly divided into the following four parts to discuss in detail.The first part is an overview of the DRG payment system of basic medical insurance for units directly managed by S Province’s governments.This part introduces the concept,objectives and application scope of the DRG payment system,reviews the development of DRG payment at home and abroad.The second part is the significance of DRG payment and the feasibility analysis of DRG payment system of basic medical insurance for units directly managed by S Province’s governments.The medical insurance DRG payment system is a system that divides hospitalized cases into groups and pays for medical insurance according to the payment standard of the group.The DRG payment system has important meanings such as saving medical insurance funds,improving the quality and efficiency of medical services,and reducing the burden on the insured.Compared with the traditional payment by project,the DRG payment system has the characteristics of total regional budget and inspires hospitals to actively reduce costs.It helps to solve a series of problems caused by paying by project.It is found through research that the basic medical insurance for units directly managed by S Province’s governments has the feasibility of implementing DRG.The third part is the practice of the DRG payment system of basic medical insurance for units directly managed by S Province’s governments,and explores the implementation background,practices and operational effects of of the DRG payment system of basic medical insurance for units directly managed by S Province’s governments.This article understands the DRG implementation background from the income and expenditure of the medical insurance fund in the past 5 years,the use of medical insurance funds in different insured groups,different levels of hospitals,and changes in hospitalization expenses.It reviewed the implementation,policy formulation and management of DRG payment.Finally,this paper analyzes the effect of DRG payment through the expenditure of medical insurance funds,the changing trends of various medical service indicators of the pilot hospitals,and the changing trends of the insured’s own expenses.The results show that the DRG payment system has been achieved.It has achieved a good implementation effect,and has achieved obvious results in saving medical insurance funds,improving the quality of medical services,and reducing the burden on patients.The fourth part is the potential risks of the DRG payment system of basic medical insurance for units directly managed by S Province’s governments and prevention suggestions.It analyzes the potential risks of DRG payment,and puts forward implementation suggestions for the existing risk points.After in-depth analysis,due to the characteristics and management methods of DRG,the DRG payment system has the following four potential risks: First,the medical record basis of medical institutions affects the authenticity of the grouping results;second,it hinders the development of new medical technologies;third,Medical institutions may maximize benefits through irregular behavior;fourth,it causes uneven development of hospitals in the region.In response to the above risks,this article puts forward corresponding prevention suggestions from four perspectives: one is to strengthen the basic work management of medical records and ensure the accuracy of enrollment;the other is to improve the DRG payment policy and handling process,and to list special diseases for inapplicable situations;the third is to establish a DRG payment supervision and assessment system to solve the problem of violations of medical institutions;the fourth is to establish a comprehensive performance evaluation and incentive mechanism to guide the rapid development of medical institutions.