The DRG/DIP two payment method reform pilots began at the end of the last century... So in such a "race" team, what is the view of clinicians on the reform of medicare payments? And how will they respond?
The author | to do so
Source| Zhu Ren on medical humanities
The DRG payment method began with the release of the National Health Insurance Bureau in 2019, and the National Health Insurance Bureau released the DIP payment method again the following year. In fact, these two payment method reform pilots have been around since the end of the last century, but they are narrow and not many people know about them.
Both payment reforms have selected some cities as pilots, with 30 DRG pilot cities nationwide and 71 DIP pilot cities. There are also some cities that are piloted in the province, which is said to be more than 100, so that there are already more than 200 cities in the country where the pilot DRG or DIP payment is calculated.
However, the progress of the pilot cities is different, just like the race, after the starting gun sounds, the athletes run their own, some have begun to run, and some are even warming up.
Judging from the list of demonstration cities released at the end of 2021, DRG18, DIP12, Shanghai and Tianjin belong to DRG/DIP. That is, these 32 cities are running ahead.
So in such a "race" team, what is the view of clinicians on the reform of medicare payments? And how will they respond? I looked for survey data from different pilot and launch stages to see the ideas and practices of TCM physicians at different stages.
A survey from the Social Insurance Security Center of the Beijing Economic and Technological Development Zone collected 114 valid questionnaires for physicians from November 5 to 14, 2020, involving 71 hospitals in 24 cities.
Of these, 13 were from pilot hospitals, 42 from non-pilot hospitals, and the remaining 59 did not know whether their own hospitals were piloted.
The following is known from the perspective of different job titles, only 10 people are more familiar, 2 people are very well understood, and it is estimated that these 12 people are from pilot hospitals.
A survey from a medical institution in Shenzhen that began pilotING DRG payments in September 2019 from June 2020 to May 2021. Valid questionnaires 84 copies. You can see a significant increase in cognitive level, very understanding reached 22.6%, probably know that it rose to 65.5%.
Looking at the results of a survey by a medical institution in a prefecture-level city in Jiangsu, they began to pilot DRG in 2017, and the survey was done in May 2019. Due to the long time to carry out the reform of medical insurance payment, the problem has become the specific operation of DRG.
Relatively speaking, the level of awareness of the importance of the first page of the case is particularly high, while the level of awareness of performance-related and quality-related issues is low.
Let's look at a survey of a top three hospital in Beijing, 83 clinicians participated in the survey, and only 11 people were familiar and proficient. And only the basic knowledge of DRG is relatively understood, and other cognitive levels are low.
Let's see how the doctors react at different stages.
According to a survey by the Social Insurance Security Center of the Beijing Economic and Technological Development Zone, 28% support for 24% for 24% of the support.
A medical institution in Shenzhen belongs to the early stage of the pilot, and only 9% believe that it does not affect medical behavior.
The following are significant changes:
1. Pay attention to the increase in medical costs
2. The average cost is reduced
3. Shorten the length of hospitalization
4. Auxiliary inspection is reduced
5. Increased referrals
6. The rate of re-hospitalization increases
The situation of medical institutions in a city in Jiangsu Province is much better, after 2 years of pilot, 91% of medical staff actively support and actively cooperate. The author believes that it is related to the organization of multiple forms of training by the Medical Insurance Section.
Similarly, according to a survey from a third-class hospital in Beijing, 90% of doctors want to have a deep understanding of DRG and are willing to participate in relevant training.
Summarizing the above content, we can see that the doctors at different stages of the medical insurance payment reform have different reactions, when the doctors have not yet been exposed to the relevant assessment, then not too much attention, and after the start of the pilot, the degree of attention has risen, but it does not involve the interest issue, so the degree of attention is not the highest, with drg/DIP payment and hospitals, departments, individual performance linked, then the doctor's cognition will rise faster, the training demand will be stronger. (Original title: Drg/DIP Payment Reform At Different Stages of Doctors' Reactions)
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