TCM needs to have better efficacy and lower costs
"Chinese medicine can not implement DRG for the time being", this news has boosted the recent madness of the Chinese medicine sector.
But "not yet" ≠ "never". Since the beginning of this year, some provinces and cities have taken the lead in carrying out the reform of medical insurance payment for traditional Chinese medicine services, and planted the flag of DRG on traditional Chinese medicine.
On January 12, Guangdong Province issued the 14th Five-Year Plan for the Development of Health and Health In Guangdong Province, and on the same day, the Information Office of the People's Government of Guangdong Province held a press conference on the plan. Li Jintang, deputy director of the Guangdong Provincial Medical Insurance Bureau, made it clear that experts will be organized to select the dominant diseases of traditional Chinese medicine in batches, implement payment by disease, and carry out the reform of the medical insurance payment system for traditional Chinese medicine services.
Guangdong is a major province of traditional Chinese medicine, and the launch of traditional Chinese medicine DRG has attracted the attention of the industry. Prior to Guangdong, the Nanjing Municipal Medical Insurance Bureau issued the "Interim Measures for Payment by Disease Diagnosis Related Grouping (DRG) Point Method for Basic Medical Insurance in Nanjing" on January 5, officially opening the reform of DRG payment methods, taking the lead in using TCM groupings, and piloting TCM groups for some TCM dominant diseases.
In the context of the full rollout of DRG/DIP, chinese medicine cannot be left alone, and it is already a foregone conclusion. The policies of Guangdong and Nanjing may promote other provinces and cities across the country to carry out Traditional Chinese Medicine DRG, which is not a good thing for the current hot concept of Chinese medicine in the capital market.
Change is always going to happen.
The traditional Chinese medicine DRG is in line with the national opinion
The Guangdong Provincial Medical Insurance Bureau detailed the specific practices of Drrg in traditional Chinese medicine:
TCM advantage outpatient diseases are paid by disease, that is, DRG; TCM advantage inpatient diseases and TCM daytime treatment diseases are paid by disease value, that is, DIP. For the dominant diseases of traditional Chinese medicine that are treated for long-term hospitalization, the cost of traditional Chinese medicine is paid according to the bed day; for diseases that are mainly treated by Western medicine and increase the services of traditional Chinese medicine, the score is appropriately increased; and for diseases that attach equal importance to traditional Chinese medicine and Western medicine, the same price of the same disease and the same disease of western medicine are implemented.
This DRG implementation policy is in line with the spirit of the reform of the medical insurance payment method of the National Medical Insurance Bureau.
DRG/DIP is a method of payment for expenses grouped by disease. At the end of November 2021, the National Medical Insurance Bureau issued the "Three-year Action Plan for the Reform of DRG/DIP Payment Methods", which requires that DRG/DIP cover all eligible medical institutions by the end of 2025, and basically achieve full coverage of disease types and medical insurance funds.
Although at the end of December 2021, the State Medical Insurance Bureau and the State Administration of Traditional Chinese Medicine jointly issued the Guiding Opinions on Medical Insurance Supporting the Inheritance and Innovative Development of Traditional Chinese Medicine, proposing that TCM medical institutions can temporarily abstain from dreg, and appropriately increase the coefficients and scores of TCM medical institutions and TCM diseases in areas where DRG and DIP have been implemented.
Under normal circumstances, TCM medical institutions often need to combine Western medicine diagnosis and treatment and Traditional Chinese medicine, which produces more consumption than ordinary Western medicine hospitals. If DRG is fully implemented, many TCM hospitals may face losses.
"When DRG first came out, our TCM hospital was very scared." In October 2021, Wen Lixin, secretary of the Party Committee of Sanming Integrated Traditional Chinese and Western Medicine Hospital, made a public statement. Previously, he had repeatedly asked Xu Zhiluan, director of the Sanming Municipal Medical Insurance Bureau, to "grind hard bubbles" and hope to increase the cost of the TCM patient group, but was rejected, on the grounds that "TCM needs better efficacy and lower costs".
Therefore, when the "Guiding Opinions" supporting traditional Chinese medicine was issued at the end of December, it was clear that the DGR of traditional Chinese medicine was suspended, and people in the industry breathed a sigh of relief. Chinese medicine has received special treatment and "safe haven", so it has led to a round of surge in the concept of Chinese medicine stocks.
However, the "Guiding Opinions" also make it clear that it will continue to promote the reform of TCM medical insurance payment methods, explore the implementation of DRG/DIP for TCM diseases, select diseases, determine scores, dynamically adjust, and carry out daytime TCM medical services and implement DRG for TCM diseases with long treatment cycles, controllable risks, and continuous treatment.
Although the National Medical Insurance Bureau did not specify when to carry out TCM DRG, at the end of December, the state issued the "Medical Insurance Version of TCM Disease Classification and Code", and from January this year, the classification and code of TCM diseases have been unified nationwide.
This step is obviously to pave the way for the implementation of TCM DGR nationwide.
Policy continues to tilt, but reforms have not stopped
Guangdong is a major province of traditional Chinese medicine. In recent years, the annual output value of Guangdong's traditional Chinese medicine industry has exceeded 60 billion yuan, and the scale of the traditional Chinese medicine consumption market ranks first in the country. The province's types of Chinese medicinal materials account for 20.7% of the country, and there are more than 240 national protected varieties of traditional Chinese medicines.
Traditional Chinese medicine is welcomed by the masses in Guangdong, so Guangdong Province has always been at the forefront of the reform policy for traditional Chinese medicine.
In early September 2021, Guangdong Province took the lead in launching the Procurement Alliance of Proprietary Chinese Medicines in the country, including 36 exclusive varieties such as Lianhua Qing plague into the collection. In December 2021, Guangdong, together with seven provinces including Shanghai and Zhejiang, became the first batch of national demonstration zones for the comprehensive reform of traditional Chinese medicine.
On the other hand, Guangdong, a major province of traditional Chinese medicine, must also assume the role of exemplary example. The National Medical Insurance Bureau has always emphasized the policy preference for traditional Chinese medicine. Guangdong has introduced specific practices: to include eligible proprietary Chinese medicines, Chinese medicine tablets, traditional Chinese medicine hospital preparations, as well as acupuncture, orthopedic rehabilitation, and therapeutic massage into the scope of medical insurance payment in Guangdong Province.
In addition, Guangdong Province also supports primary medical institutions to carry out traditional Chinese medicine services, and gives priority to the inclusion of traditional Chinese medicine and traditional Chinese medicine special diagnosis and treatment projects into the scope of outpatient specific disease medication and diagnosis and treatment. Support grassroots medical institutions to carry out traditional Chinese medicine services such as chronic diseases and medical rehabilitation.
At present, there are 23,000 TCM medical institutions and 192 TCM hospitals in Guangdong Province, including 36 Tertiary Grade A Chinese Medicine Hospitals and 72 Grade II Grade A Chinese Medicine Hospitals. Under the planning of the Medical Insurance Bureau, all municipal TCM hospitals will create tertiary hospitals, and all county TCM hospitals with a permanent population of more than 300,000 will create second-class hospitals.
Therefore, it is imperative for Guangdong to implement TCM DRG. Moreover, in terms of specific policies, Guangdong stipulates that chinese medicine and Western medicine have the same price for the same disease, which also reflects the inclination towards Chinese medicine.
In the DRG Interim Measures set by Nanjing, appropriate care is also given to Traditional Chinese medicine, making it clear that if the disease group included in the Chinese medicine DIP is lower than the corresponding Western medical group, it will be adjusted according to the Western medical group.
DIP is paid in points, and if the same group of patients has fewer TCM points, the payment will naturally be less. Pulling up the same points as Western medicine actually encourages hospitals to carry out more TCM treatment.
Chinese medicine DRG/DIP is the trend of the times. Only under the continuous encouragement, guidance and regulation of policies can the development of traditional Chinese medicine get rid of barbaric growth, develop in a high-speed and orderly manner, and benefit patients.
#Chinese Medicine Concept ##中医DRG模式 #