Comprehensive reform+punishing corruption, so that there is nowhere to hide over-medical treatment.


Comprehensive reform+punishing corruption, so that there is nowhere to hide over-medical treatment.

In the ongoing medical anti-corruption storm, the case of the dean of a hospital in Zhongshan, Guangdong Province is impressive: the amount involved in the corruption of the dean is more than 29.8 million yuan, and the related kickbacks and inflated drug and equipment prices are included in the medical cost, which directly leads to the people’s "difficulty in seeing a doctor" and "expensive in seeing a doctor". After the dean was arrested, the average outpatient and inpatient expenses in this hospital decreased by 16.6% and 21.4% from January to May this year, and the per capita medical cost decreased by more than 1,400 yuan.

The reason why this medical anti-corruption storm has received such extensive attention is because the people are worried that these corrupt funds, which are often tens of millions of yuan and hundreds of millions of yuan, will eventually be passed on to themselves through excessive medical care. Medical behavior is professional and has high barriers, so ordinary people have no ability to identify whether they have been overtreated. It is precisely because of the lack of recognition ability that ordinary people may transfer their anxiety and resentment about excessive medical care to every doctor they come into contact with, resulting in innocent doctors being implicated.

The cancer of the industry of over-medical treatment did not happen in a day, and the country’s efforts to cut this cancer did not start today. In 2017, the reporter followed the former National Health Planning Commission to investigate the local medical reform in Lufeng County, Yunnan Province. The reform in this county has enabled doctors to increase their income by saving money for patients. A deputy chief physician interviewed by the reporter at that time had a monthly salary increase of about 50%. At the same time, the average hospitalization cost in Lufeng County was 3,308 yuan, which was 446 yuan lower than the provincial average.

This reform focuses on the payment method of DRG(Diagnosis Related Groups). DRG refers to classifying patients into disease groups according to clinical similarity and resource consumption similarity, and making medical expenses standards for payment in groups.

At that time, Lufeng County People’s Hospital established 294 disease groups, covering 26,029 disease diagnoses. For example, if the cost of a certain disease group is 5,000 yuan, then the medical insurance department will pay 5,000 yuan to the hospital for this disease group. If the patient only spends 4,700 yuan on treatment, the balance of 300 yuan will be controlled by the hospital. If it costs 5,300 yuan, the excess 300 yuan will also be paid by the hospital. Under this payment mode, the hospital has become the cost controller, from the original "asking me to control fees" to "I want to control fees", avoiding excessive medical behaviors such as excessive inspection and indiscriminate use of drugs.

In addition, in order to prevent hospitals from "cutting corners" in the process of medical services in order to increase income, at that time, the medical insurance department of Lufeng County stipulated that the balance rate should not exceed 7% of the medical expenses standard, and the medical insurance department that exceeded 7% would recover it. The medical insurance department also reserves 3% of the "export", that is, the top 3% patients with the most expensive medical expenses in each disease group are reimbursed by project, which is not limited by the DRG payment standard, so as to dispel the doubts of doctors in treating incurable patients.

DRG payment method originated in the United States. In 2019, shortly after the establishment of the National Medical Insurance Bureau, it began to promote the reform of DRG payment method in more than 30 cities across the country. Due to the complexity of China’s national conditions, while promoting DRG, China has developed an original DIP payment method reform, which was piloted in 71 cities across the country in 2021. Although the two are different in specific operation, the underlying logical thinking is the same: let the hospital become the cost controller and control the excessive medical treatment from the root.

According to relevant documents, from 2022 to 2024, China has fully completed the reform of DRG/DIP payment methods. By the end of 2024, all medical insurance co-ordination areas in China will carry out the reform of DRG/DIP payment methods, and start the pilot areas in advance to continuously consolidate the reform results; By the end of 2025, DRG/DIP payment will cover all eligible medical institutions that provide hospitalization services, and basically achieve full coverage of diseases and medical insurance funds.

The reform will certainly touch the interests of some people. At present, the ongoing medical anti-corruption storm is precisely the severe rectification of illegal interests. While focusing on "key minority" and key positions, the anti-corruption storm also covers the whole chain of production, circulation, sales, use and reimbursement of the pharmaceutical industry, as well as the entire pharmaceutical field. It is expected that with the comprehensive promotion of reform and the crackdown on corruption, there will be no hiding place for over-medical treatment. Only in this way can we really protect angels in white and make the doctor-patient relationship return to purity.

Liu Changrong Source: China Youth Daily

Source: China Youth Daily


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