Chapter 534: Amateurs guide experts

Xu Qiu said: "I promised Academician Shen Hua before that I would go to various hospitals to give academic lectures with the expert group of the Brain Association..."

Fu Qing's expression changed slightly and asked: "Are you going out of the province?"

In Baiyun Province, he can still strengthen the security of Xu Qiu so that the people of Huining will not dare to have any bad thoughts.

But if he goes out of the province, the danger level will rise sharply.

Xu Qiu said without changing his expression: "Daxia is still a society ruled by law. Huining is big, but it is not lawless."

Fu Qing nodded: "In this case, this document cannot be released for the time being, otherwise Huining will immediately guess your intention to leave the province and may inform these experts in advance."

But after thinking for a moment, he showed a worried expression again: "It's not okay to postpone it. If you leave Baiyun Province at this juncture, Huining may threaten your safety. With the help of policies and the media, Huining's conspiracy will be exposed, and they will not dare to touch you!"

Seemingly having made a decision, he finally slammed the table and finalized it, saying: "Let's do it this way. The province will issue a ban notice in the next two days. At least your safety is guaranteed."

Fu Qing can't let Xu Qiu get into trouble.

He is involved in too many national key surgeries, and he is also responsible for the competition for the first hospital in the south, the evaluation of the second Daxia neurosurgery center, and the hope of the rise of Baiyun Province's medical level.

Xu Qiu didn't say much.

The early release of the ban policy had little impact on him. Hui Ning was already paying close attention to Xu Qiu. As long as he left Baiyun Province, combined with the traffic trajectory, he would find out who Xu Qiu had visited in addition to giving academic lectures on neurosurgery, and naturally he would know what he was going to do.

"Secretary Fu, have you heard about the DRGs grouping?" Xu Qiu mentioned another purpose of this trip.

Fu Qing's face sank slightly, and he nodded: "I know, the province has held more than a dozen meetings to discuss it in recent years... I have no way."

DRGs is actually a typical policy product of laymen guiding insiders.

Although Daxia's medical insurance has a wide coverage, it has a fatal problem: it is impossible to review the case of each insured patient in a meticulous manner, and it is even more impossible to check the treatment measures, diagnosis and treatment plans one by one.

This has led to a large-scale insurance fraud phenomenon at the grassroots level.

At the same time, the abuse of medical insurance funds in various places has also aggravated the shortage of funds for medical insurance expenses of the National Health Commission. In recent years, medical insurance has become increasingly tight, and the continuous emergence of new therapies and new equipment has repeatedly raised medical expenses, resulting in increasingly stretched medical insurance funds.

The medical insurance fund is in a panic, and the National Health Commission is also trying to find a solution. There are only two ways: increasing revenue and reducing expenditure.

"If you want to make up for the deficit in medical insurance, you have to increase the price of medical insurance... But this is obviously impossible, and the people will not agree." Fu Qing said bluntly.

Xu Qiu nodded, expressing his understanding.

Fu Qing tapped the solid wood table lightly with his index finger and said slowly: "Then, the only thing we can do is to save money.

"Over the years, the National Health Commission has actually made a lot of efforts. For example, the clinical pathways a few years ago and the payment for single diseases are all efforts to accurately reimburse and reduce medical insurance expenditures.

"But one by one, all failed. These systems have a huge flaw - the differences between regions and hospitals are too great. The National Health Commission cannot formulate payment strategies of different specifications based on the standard deviation and variation rate of each hospital.

"In desperation, DRGs came into being. In fact, this is the best solution to the current medical insurance deficit. It does not need to consider the level of medical care or the differences between patients. Instead, it is based on management and the huge patient data of the whole country. It is much better than clinical pathways and single disease payment. "

Xu Qiu was silent.

Daxia's implementation of DRGs is actually a way to cross the river in Meiguo.

In the 1980s, Meiguo's old-age and disability health insurance fund was once on the verge of bankruptcy. In the previous 17 years, the average annual growth rate of medical expenses in Meiguo was as high as 17%, and the total scale soared from 3.4 billion US dollars in the 1960s to 37 billion US dollars in the early 1980s, more than ten times.

The following year, Meiguo's Medicare hospitals could not bear the pressure of tight health insurance funds and financial pressure, so they launched the DRGs-PPS system, which is the predecessor of DRGs.

In short, it is to predetermine the cost, and after the patient is discharged from the hospital, report it to the US Medical Insurance Center, and the center will allocate funds according to the stipulated cost-no matter how much the treatment costs in the end, the money given by the Medical Insurance Center will not change.

In the DRGs-PPS system, hospitals can only make profits by saving costs , and Medicare hospitals took advantage of this to clear the chronic disease of tight medical insurance, and turned losses into profits by reducing the treatment costs of hospitalized patients. Not only did the cost control effect come immediately, but the hospital's income also increased significantly.

For this reason, the DRGs-PPS system was passed by the United States in the following year and became the basic payment system for elderly medical insurance in the United States. It then gradually developed into a more complete DRGs, and was introduced by Europe, Australia and some Asian countries a few years later.

Daxia's previous medical insurance was "charged by project".

This system is almost entirely for patients. As long as it is an examination, treatment, hospitalization, surgery, etc. during the medical treatment process, it can be reimbursed. The cumulative total of all medical means is how much the medical insurance will give according to the reimbursement ratio.

But soon there were drawbacks. Under the impetus of "charging by project", more and more examinations were carried out, and the prescriptions for medication became more complicated, and the profits of hospitals rose accordingly.

During that period, every hospital was crazy about accepting patients. Even if it was just an ordinary case of high blood pressure, a series of reasonable but unnecessary examinations could get hundreds or even thousands of yuan from the medical insurance.

Various major surgeries were even more attractive. Each patient was a walking 10,000 yuan bill...

The implementation of "charging by project" almost caused the medical insurance fund to collapse.

Later, emergency adjustments were made to slightly stop the phenomenon of "big examinations and big prescriptions".

Today's DRGs are actually the common demands of patients, hospitals, and medical insurance bureaus. Patients hope to do fewer examinations and prescribe fewer drugs to reduce their out-of-pocket expenses. Hospitals are fussy about using the pitiful medical insurance fees, fearing that they will exceed the hospital's own expenses in the future; medical insurance is worried about its own deficit and bankruptcy...

In this case, DRGs that can solve over-medicalization, stimulate hospitals to control costs, and thus reduce patients' medical expenses are extremely attractive.

Its key is to encourage medical institutions to adjust the diagnosis and treatment structure, reduce non-human costs, such as equipment and drugs, and increase human remuneration.

However, its success depends on two foundations: high-quality clinical diagnosis and treatment capabilities, and extremely detailed data on capital expenditures.

Fu Qing sighed helplessly, revealing an embarrassment.