What does that Notice of Pilot Work on Payment by Disease Group DRGs mean

The "DRGS" pilot project means that hospitals pay according to the type of disease, severity, means and other conditions of the patient's disease-related grouping, and the pilot work is currently being carried out in individual areas, as follows:

DRGS (Diagnosis Related Groups) Chinese translates to (disease) diagnosis-related classification, which divides patients into 500-600 diagnosis-related groups according to factors such as age, gender, length of hospitalization, clinical diagnosis, illness, surgery, disease severity, comorbidities and complications and prognosis, and then decides how much compensation should be paid to the hospital. DRGS is recognized as one of the more advanced payment methods in the world today.

The guiding ideology of DRGS is to achieve the standardization of medical resource utilization through the formulation of a unified fixed payment standard for disease diagnosis and classification. It will help motivate hospitals to strengthen medical quality management, force hospitals to take the initiative to reduce costs, shorten the length of hospitalization, and reduce induced medical expense payment in order to obtain profits, which is conducive to cost control.

In the process of implementation, many countries have found further advantages: it effectively reduces the difficulty and cost of management of health insurance institutions; It is conducive to macro-level and control of medical costs; It provides a scientific and comparable classification method for the evaluation of medical quality.

The basic starting point of the DRGS for the medical expense payment system is:

The payer of medical insurance does not pay according to the actual expenses of the patient in the hospital (i.e., according to the service item), but according to the disease-related grouping of the patient's disease type, severity, ** means and other conditions. Depending on the condition, the patient, and the means, there will be different DRG codes.

The definition generally includes the following three parts:

Clause. First, it is a scheme for patient classification. As a case combination approach, the core idea of DRGS is to group cases with the same characteristics in one aspect to facilitate management.

Second, the basis of the DRGS classification is the patient's diagnosis. On this basis, the patient's age, whether surgery is performed, complications, and comorbidities are considered.

Clause. Third, it links the hospital's ** to the patient and the expenses incurred, thus providing a basis for the formulation of payment standards, especially the implementation of prepayment.

After reading the above information, I don't know if you are clear? Paying by disease group is more scientific and much simpler than paying by single disease. Beijing has now selected 108 disease groups for the pilot.

But ordinary people don't need to understand this too much. This is actually a means of medical expense management, which is conducive to controlling the diagnosis and treatment behavior of designated hospitals and reducing the phenomenon of overpayment of medical expenses.