Recently, there were media reports that the hospital refused to accept the operation of a child with leukemia, and a patient with multiple myeloma was turned away because of the complexity of the disease.
How did these heart-wrenching situations come about?
Aren't hospitals supposed to save lives, and why do they refuse patients?
In fact, all of this is because of the controversy caused by the medical insurance payment reform, and behind all this, it is because of the implementation of the DRG medical insurance payment system.
The DRG system is a payment system that fixes the amount of medical insurance reimbursement, and for hospitals, they need to bear their own expenses when they encounter the situation of "less and no compensation", so that hospitals or doctors will refuse to accept complex cases for economic interests.
This will lead to hospitals or doctors rejecting patients in order to avoid "less and no compensation", so that the quality of medical services will be greatly reduced, so how did the DRG medical insurance payment system come about?
What are its advantages and disadvantages?
1. Advantages and disadvantages of the DRG system.
The DRG system is the abbreviation of "Diagnosis Related Groups", that is, the diagnosis related medical payment group, and this system is a fixed payment system for medical insurance reimbursement amount.
This payment system is a unified payment method, that is, the amount paid by medical insurance is the same for patients with the same disease, and the amount paid for different diseases is also different.
In this way, the amount of medical insurance payment can be reduced, and at the same time, the efficiency of the hospital can be improved, preventing the hospital from over-treating and improving the efficiency of the hospital.
At the same time, it can also reduce the burden on patients, and at the same time, it can also enable patients to get more reasonable treatment, and for doctors, it can also motivate doctors to reduce the treatment cost of patients, and at the same time, it can also reduce the length of hospital stay of patients and improve the treatment effect.
However, this system also has its shortcomings, because the DRG system is a payment system that fixes the amount of medical insurance reimbursement, so when the hospital accepts patients, if the patient's condition is more complicated, more examinations are required, and even high-priced drugs may be used, so that the hospital will have a situation of "less and no supplement", so that the hospital will refuse to accept such patients.
For doctors, they do not dare to prescribe irrelevant tests and drugs after the implementation of medical insurance DRG, which will lead to patients not receiving reasonable treatment.
At the same time, it will also affect the enthusiasm of doctors, because after the implementation of medical insurance DRG, doctors' salaries will not increase, then doctors will have no motivation to motivate, so doctors will treat patients irresponsibly.
Therefore, when the medical insurance department implements the DRG system, it should carry out some training for doctors, and at the same time strengthen supervision to prevent the impact on the rights and interests of patients, and also strengthen the supervision of hospitals to avoid hospitals rejecting patients.
2. What is the starting point of the medical insurance DRG system?
The starting point of the DRG system is to prevent excessive medical treatment and improve the efficiency of hospitals, and at the same time, it is also to reduce the burden on patients and make it possible for patients to receive appropriate treatment.
At the same time, this system can also make patients more fair to enjoy the treatment of medical insurance payment, and at the same time can motivate the enthusiasm of doctors, but also improve the work efficiency of doctors, but it has just been introduced in China, and the management experience is insufficient, so in this process, there will be some side effects.
Therefore, in the process of implementing the medical insurance DRG system, it is necessary to fully communicate with medical institutions and doctors, and at the same time, it is also necessary to establish an incentive mechanism to avoid affecting doctors' service attitude towards patients because of economic interests.
At the same time, in the process of reform, it is necessary to support and train doctors and hospitals to improve their understanding and ability to respond to the new system, and ensure that the quality of medical services is not affected.
At the same time, it is also necessary to strengthen the supervision of hospitals and doctors to avoid affecting the quality of medical treatment for patients due to the implementation of the DRG system.