The General Office of the Jiangsu Provincial Government has issued the Opinions on Further Deepening the Reform of the Payment of Basic Medical Insurance, clarifying that the province will fully implement the multi-compound medical insurance payment under the control of the total amount, focusing on the implementation of hospital payment systems based on diagnosis-related groups for both inpatients and outpatients.
Hospital payment systems based on diagnosis-related groups refers to the implementation of the unified price for disease treatment programs that pay for a single disease, and social security agencies pay hospitalization fees to designated medical institutions according to the standard and inpatient numbers. Jiangsu has piloted this payment method since 2012.
For example, 200 yuan per case is charged for day surgery on breast benign tumor excision in accordance with the provisions of Jiangsu with 80% of the expenses reimbursed by medical insurance and 560 yuan charged to the patients accounts.
In the case of the expenses exceeding 2800 yuan, the hospital takes care of the excess while for cases with the expenses less than 2800 yuan, the insurance will pay in accordance with the provisions and the hospitals retain the remaining part.
The Opinions clearly stipulates that by 2018 each prefectural city will put into practice the hospital payment systems based on diagnosis-related groups for more than 150 kinds of diseases. By 2020, hospital payment systems based on diagnosis-related groups will cover at least 200 diseases while the reform of medical insurance will cover all medical institutions and medical services.
