At the end of the year, we will try to pay according to the score of diseases

On October 19, the State Medical Insurance Bureau issued the notice on the pilot work plan of total budget of regional point method and payment according to disease score. According to the notice, the pilot work will no longer specify the total amount control index of each medical institution, but convert the payment units such as items, disease types and bed days into certain points. At the end of the year, the actual value of each point can be obtained according to the total number of points provided by each medical institution and the expenditure budget index of regional medical insurance fund, and the payment shall be made according to the actual points of each medical institution. < p > < p > < p > < p > < p > the circular proposed that the coordination region should establish and improve the negotiation mechanism between medical insurance agencies and designated medical institutions, and reasonably determine the total budget index of medical insurance. At the national level, the index database of disease category score and the classification standard of core and comprehensive diseases were determined. According to the local data and the unified disease combination rules, the pilot cities have formed their own disease score catalogue, core disease types and comprehensive disease species database. According to the data of the first three years in the pilot city, the average medical expenses of the whole sample data cases were calculated to determine the score of core diseases. For the cases with comprehensive diseases and abnormal high value, the disease score can be determined by case discussion and expert review. For cases with abnormally low value, the disease score was determined according to the actual cost. Determine the use of bed days for psychiatric, rehabilitation and hospice patients with longer hospitalization time. < p > < p > < p > according to the requirements of the notice, the medical insurance agency should pre allocate funds for a certain period according to the total amount of fund budget expenditure in this year, and settle the accounts according to the point method within the cycle. The pilot cities carried out disease cost calculation, classified and summarized the disease types and cost data, and calculated the score according to the average cost of each disease. The score floating mechanism was tried out, and the grade coefficient of medical institutions was introduced to distinguish the scores of different levels of medical institutions and adjust them dynamically. For the diseases that are suitable for diagnosis and treatment in primary medical institutions and have the ability of diagnosis and treatment, the disease score standard should be consistent in different levels of medical institutions. At the end of the year, we will carry out performance appraisal on medical institutions, and link the performance appraisal with the year-end liquidation according to the agreement. It is understood that by the end of October this year, the National Health Insurance Bureau will assess and determine the list of pilot cities, and preliminarily complete the framework of the national disease combination catalogue and relevant basic standards.