Beijing 6 hospitals tries to see the doctor and guide

Beijing 6 hospitals tries to see the doctor and guide prices The excess patient needn't pay
From the 1st next month, the medical insurance patient effecting an insurance in this city is in the hospital treatment of the pilot hospital, will close the hospitalization cost according to the way of paying of grouping of number, say that there is " guide prices " in hospital a bit more popularly . The first batch of pilot projects include third hospital, Friendship Hospital, Chaoyang hospital, fixed hospital of Xuanwu Hospital, 6 of medical insurance of God Temple Hospital in the People's Hospital, Peking University of Peking University. When the time comes, personnel go to a doctor procedure, medical insurance submit an expense account in the range and does not change to effect an insurance, the burden of the medical fee will be lightened. This city will pursue the area paid according to the grouping of number if this city will become the whole country too firstly.


108 disease groups launch a pilot project first

At present, the medical insurance of this city is paid according to the project mainly, some hospitals present writing a prescription more, checking more, great prescription,etc. " excessively " Medical behavior, the hospitalization cost is unreasonable to increase that stimulate. And it is according to many kinds of factors such as patient's age, disease diagnosis, amalgamating disease complication, disease severity and curative effect to pay according to the grouping of number, will diagnose the close patient in hospital with close treatment means, with close hospitalization cost, assign to and enter several disease groups to pay by norm.

It chooses hospitalization costs to be relatively close to, the intersection of case and 108 the intersection of disease and group that quantity concentrate relatively as pilot project this time, if the coronary artery puts up a bridge, not accompanies amalgamating disease and follows the disease to guide prices it is 88843 yuan, congenital heart disease is 8906 yuan, crystal operation (cataract) It is 7158 yuan.

" guide prices " Change dynamically

The social average hospitalization cost of the same disease group of year of the above quota standard paid according to the grouping of number, as paying the standard. Namely medical insurance tertiary hospital treat whom the same medical insurance of number grouping patient take place actually accord with the intersection of this city and basic medical insurance, wipe out second-class expenses of range by fixed position last year according to this city, confirm the quota payment standard of grouping of this number.

So-called the intersection of quota and standard, include, effect an insurance personnel one admitted to hospital take place, wipe out medicines and hospitalization cost to make a diagnosis event in the range all. Medicines of personnel substantially as using and submitting an expense account outside the range and project of making a diagnosis need to be at one's own expense separately in the quota standard to effect an insurance. Will be adjusted to pay the quota standard fixedly or irregularly according to many kinds of factor according to the grouping of number.

The expenses: Persons who effect an insurance and medical insurance fund take on together

This pilot crowd covers personnel for the medical insurance of this city, including it is medical insurance personnel, basic medical insurance personnel of urban residents, shut personnel and socialized medicine personnel,etc. newly and agriculturally that the urban worker is basic.

Participate in urban worker's medical insurance and personnel of the medical insurance of urban residents, is paid the standard and effected an insurance by norm personnel and Medical Benefits Funds pay togethered. Effect an insurance personnel need, pay, get up, pay expenses, medical insurance bind the intersection of line and above expenses, get up pairs of line and bind among the line needing expense that individualing affording in proportion under the line in hospital. Quota and difference of relevant expenses of the medical insurance paid of persons who effect an insurance, are paid by the medical insurance fund.

Personnel will lighten the burden to effect an insurance

After paying according to the grouping of number, effect an insurance personnel go to a doctor procedure, medical insurance submit an expense account in the range and does not change, still hold the card and seek medical advice, settle account in real time.

After the reform, effects an insurance the patient's medical fee burden will be lightened, will use medicines in " medicines catalogue ", no longer distinguish Class A and class-B medicines, and include the range in submitting an expense account according to class-A medicines. For instance 582 kinds of class-B medicines such as the not west forest particle pharmaceuticals, soft capsules of healthy tendency of wrinkled giant hyssop of A, need individual before including in wiping out to afford 10% of the expenses in advance according to the current fixed patient of the medical insurance, but after paying according to the grouping of number, no longer pay 10% of the expenses in advance, include in submitting an expense account fully according to class-A medicine. The project of making a diagnosis of using the medical insurance to submit an expense account in the range, include the range in submitting an expense account according to the class-A project too, individual no longer bears and bears the part in advance. In addition, patient actual hospitalization cost lower than quota standard, join sponsors and pay the part that individuals bore according to expense that take place actually. The actual hospitalization cost exceeds the the above-mentioned quota part, patient individual needn't bear.

Unite the list and show a patient clearly two times

After paying according to the grouping of number, the hospital needs to provide and unite the list two times to the patient while closing the account, it is decomposing the list to unite according to the expenses paid in grouping of number of actual delivery, another it unites to be medicines and detail list to make a diagnosis event one by one that take place actually.

According to the international experience of management, after paying management by norm according to the grouping of number, specific hospital may take, induce patient in hospital, divide times of treatment into or reduce essential way of service, earn improper to make profits, cause the decline of the medical service quality at the same time. As to this, Municipal Health Bureau says, will examine the pilot hospital case and fill in the situation before trying, the situation will be checked in an all-round way to organize the professional verification team to write accuracy to the case of the pilot hospital with repeating in hospital regularly after trying, find the unreasonable problem is corrected in time, serious offering is dealt with.

Reporter Xu JingJing of morning paper

Beijing 6 hospitals tries to see the doctor and guide prices The excess patient needn't pay