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The May Day holiday is over, in just five days, there are all kinds of things in the world, some people suddenly say goodbye to the world in their sleep, and some people give everything and even their lives for online lovers who have only seen two sides, birth, old age, sickness and death, life is not easy.
Speaking of illness, during the May Day period, I heard people around me talk about a strange thing, and now many hospitals do not accept "complex patients".
I looked it up online and found that hospitals across the country seemed to be refusing to admit "complicated patients" as a tacit rule.
This reminds me of the rumors that hospitals everywhere are requiring "no more than 15 days of hospitalization" at a time, and the NHSA quickly stated that it had never made such a rule.
Why are hospitals reluctant to admit "complex patients"? Why are there rumors that hospitalization does not exceed 15 days? This starts with the ongoing DRG, that is, payment according to disease group.
To introduce it in layman's terms, let's go to the hospital for treatment, and the medical expenses are divided into two parts, one part is paid by ourselves, and the other part is paid by medical insurance. For example, the total cost is 2,000 yuan, 80% of which is reimbursed by medical insurance, patients pay 400 yuan, and the remaining 1,600 hospitals have to go to the medical insurance bureau to ask for it. The advantage of this system is that it eliminates the worries of hospitals and patients, and the disadvantage is that it induces minor illnesses and major treatments, and a small problem may do a lot of examinations, and the medical insurance fund can't stand it.
As a result, the DRG system was introduced, in which the DRG first labeled each patient, and entered the corresponding group according to the label, and the medical insurance reimbursement amount for each group was fixed, and the medical insurance bureau would give the hospital a fixed amount of money, "no refund or no compensation". What does that mean?
Suppose that a patient's reimbursement of medical insurance according to the group classified by DRG is 1,300 yuan, the hospital can get 1,300 yuan from the medical insurance bureau, and the actual expenditure of the hospital is 1,200 yuan, so that 100 yuan is "earned" and there is no need to return it to the medical insurance bureau, which is called "more than no refund".
If it is classified into another group, the corresponding payment standard is 1,100 yuan, and the actual expenditure of the hospital is still 1,200 yuan, and the medical insurance bureau will not make up for the "loss" of 100 yuan, that is, "less and no compensation".
Obviously, it is impossible for the hospital's money to fall from the sky, and many hospitals will pass on the "loss" of 100 yuan to the relevant departments and attending physicians, and deduct them from their salaries and bonuses. That's why the doctor complained that "I worked hard for a month, and as a result, the department deducted the money". There is no way for the hospital to do this, and if every doctor exceeds the standard for every case, then the hospital may soon be unable to make ends meet.
According to the "Three-Year Action Plan for the Reform of DRG/DIP Payment Methods", by the end of 2024, the coverage of diseases will reach 90% in principle, and the proportion of DRG/DIP payment medical insurance fund expenditure will reach 70%. By the end of 2025, the DRG/DIP payment method will basically achieve full coverage of diseases and medical insurance funds.
Speaking of which, we have to ask, the DRG payment system is imported from the world, will foreign hospitals also refuse to accept "complex patients"? It is understood that the international common thing is that DRG payment generally only covers hospital expenses, and there is a separate payment system for doctors' fees. In China, the value of doctors' labor services is included in the DRG package payment.
Half a month ago, the National Health Insurance Administration held 5 consecutive symposiums on the reform of medical insurance payment methods, which were attended by hospital managers, front-line medical staff, and hospital medical insurance office personnel for the society, and widely listened to the opinions and suggestions on the reform of medical insurance payment methods such as DRG and DIP payment.
I sincerely hope that DRG performance appraisal and doctors' income can be separated, so as to build doctor-patient trust and achieve a win-win situation for both parties.
We can't make doctors "accountants"
When he gives us a pulse or auscultation
The mental abacus crackled
If you receive this patient number
Whether the department is losing or earning