Wang Zongfan, director of the Chinese Academy of Labor and Social Security Sciences, said that the treatment of this disease is very complicated and its cost may exceed the standard of payment for such a disease in advance, so hospitals may have various reasons to find ways to transfer costs.
At present, the focus of medical insurance payment in China is mainly on hospitalization expenses, which can not be fully covered by single disease payment, while DRG payment can basically achieve full coverage of hospitalized diseases.
What benefits will DRG bring to the people, medical institutions and health insurance funds if it is paid according to the medical group? For patients, when they are hospitalized, they know exactly how much they may spend to treat their illness, and they know more about how much they will spend. As a management mode, DRG standardizes the diagnosis and treatment behavior from the front end of payment, which helps hospitals to control costs, improve service quality and leverage management departments to improve management level.
Wang Zongfan, director of the Chinese Academy of Labor and Social Security Sciences, said that by comparing hospitals, giving them an inherent motivation, plus that the payment of health insurance now directly relates to his income, it will have greater motivation to optimize. If medical services can optimize and improve efficiency, then medical costs are relatively low, so for health insurance, it will reduce unnecessary waste.