** Payment Management New Deal

Medicare fund is the people's "life-saving money". How to ensure that every penny spent is implemented? The Municipal Human Resources and Social Security Bureau, the Municipal Health Bureau, the Municipal Finance Bureau, and the Municipal Development and Reform Commission jointly formulated the “Interim Measures for the Payment of Basic Medical Insurance in Ningbo”. Then, will the New Deal change the health insurance payment methods of the insured? After the implementation of the policy, what changes will patients feel when they seek medical treatment? Yesterday, the Municipal Bureau of Human Resources and Social Security formally interpreted this new policy.

Insured person's medical insurance payment method remains unchanged

"The New Deal is mainly aimed at controlling the unreasonable medical expenses of fixed medical institutions and designated retail pharmacies, and ensuring the sustainable development of the basic medical insurance system. It will not change the existing payment methods for medical insurance for insured personnel." Municipal Human Resources and Social Security Bureau The responsible person stated that the ultimate goal of the New Deal is to protect the rights and interests of insurers, standardize medical service behavior, control the unreasonable growth of medical expenses, and promote the development of medical institutions.

The reporter learned that the medical insurance for employees of Ningbo City and the medical insurance for urban residents began to implement city-level co-ordination on May 1, 2011 and September 1, 2012 respectively. This requires the timely unification of the basic medical insurance settlement methods in the city. The public hospital reform plan introduced in Zhejiang Province also requires the implementation of a variety of settlement methods under total control, including payment by service unit and payment by case category.

“Although the current health insurance settlement method in Ningbo is at the advanced level of the entire province, there are also situations in which the effectiveness of medical expenses control is relatively low.” The person in charge said frankly that this is exactly the problem that this New Deal must focus on.

The reporter learned that the New Deal is applicable to both the employee medical insurance and the residents' medical insurance, and has unified the settlement methods of the original six co-ordinated districts, and the whole city is applicable.

Effectively control unreasonable medical expenses

Compared with the original policy of the medical insurance fund floating payment, the new government implements a floating fee under the total amount control. That is, according to the actual medical expenses incurred by each medical fixed-site organization in the previous year's effective service volume, head-to-head ratio, etc., the total budget for each medical institution in the current year is determined at the beginning of the next year. At the end of the year, the total budget will be adjusted according to the specific service conditions, and the annual final accounts will be calculated according to the total amount of adjustments. At the time of the final accounts, there will be a certain proportion of the balances that will be shared, and a share of the overruns will be shared.

"This incentive mechanism can effectively control medical institutions' unreasonable medical expenses." The person in charge said that with total control, medical institutions must consider comprehensively, some unnecessary referrals and dispensable drugs, inspections, etc. Get control.

More standardized prescriptions

The prescription allocation policy has been implemented in Ningbo for 11 years, which not only facilitates the participation of insurance personnel, but also improves the efficiency of the use of medical insurance funds to some extent. However, in the process of implementation, there are also problems such as large obstacles in prescriptions for dispensing outside the market and difficulties in supervision, which can easily result in repeated payment of medical insurance and increase the personal burden on the participants.

The New Deal stipulates that fixed-point medical institutions will participate in annual fee settlements with prescriptions and prescriptions, and foreign prescriptions will be linked to share and share of annual expenses. “The cost of prescription drug purchases outside the fixed-point medical institutions will all be included in the actual medical expenses incurred by the designated medical institutions in the year. This will largely regulate the distribution of prescriptions,” the person in charge said.