Analysis On The Current Situation And Countermeasures Of DRGs Payment Mode Reform In Changzhou

The reform of payment method is always the key and difficult point in deepening medical reform.The sustainable operation of Medical Insurance Fund is inseparable from the reform of payment method.To deepen the reform of the payment system of medical insurance and to actively promote the application of group payment according to diseases(DRGS),the Ministry of Human Resources and Social Welfare(Mohss)has issued the "guiding opinions on actively promoting the joint reform of medical care,medical insurance and medicine"(No.56[2016] of MOHSS),explore the combination of total amount control and point number method."Provincial Government Office on further deepening the implementation of the reform of basic medical insurance payment method"(No.6[2018] of the Su Zhengban)requires: in Zhenjiang,Changzhou and other cities to carry out DRGs payment pilot.This paper takes the reform of payment mode of DRGs as the research object,firstly defines the concepts of medical insurance payment and DRGs,and then introduces the theory of Supply and demand and the game theory of payment mode.By taking the reform of the DRGs payment system in Changzhou as a case study,see its specific practice:multi-functional departments work together,step-by-step implementation of DRGs payment reform,reform work in all directions simultaneously,scientific demonstration of specific reform programs,the results of DRGs payment system reform are summarized as follows: The DRGs payment system has been established,the precision of medical insurance payment has been greatly improved,the service quality of medical institutions has been improved,and the healthy interaction between Medical Insurance Department and Health Department has been realized.While summing up the achievements,we also see the deficiencies in the work: The low level of coordination among government functional departments,the error of DRGs grouping results,the satisfaction of payment results to be improved,and the pressure of government supervision continues to increase.Through the specific analysis of the problem,the causes of the problem are found out: the lack of the operational mechanism of the reform of the mode of payment for medical insurance,the deviation of the DRGs grouping process,the optimization of the DRGs payment scheme and the imperfection of the DRGs medical insurance supervision system.In view of the existing problems,first through the experience of the United States,Germany,Australia,including the Domestic Jinhua and Liuzhou,and then compare the reasons for the problems in the reform of Changzhou DRGs payment method,to find out the corresponding measures one by one: from the mechanism level,to improve the fund management system,to establish a mechanism for the introduction and training of talents,to improve the linkage mechanism between departments;from the basic work level,improve the standardization of data transmission,improve the unity of service standards,optimize packet;from the level of optimizing payment scheme,to enhance the status of medical technology in the settlement standard,to enhance the incentive effect of the payment plan to the new technology and new material,to enhance the integration of different payment methods,to enhance the integration of the payment plan at the municipal level;From the aspect of supervision,we should establish the management system of medical behavior,set up the expert database of DRGs payment supervision,perfect the intelligent audit system and establish the evaluation system of DRGs payment.