Core Viewpoint - The Guangdong Provincial Medical Security Bureau and the Health Commission have initiated a comprehensive reform of medical insurance payment for tightly-knit county medical communities, aiming to enhance grassroots medical service capabilities and improve accessibility for insured individuals [1][6]. Group 1: Reform Objectives - The reform aims to shift the focus from "treatment-centered" to "health-centered" care, allowing insured individuals to access quality medical services locally, thereby addressing issues of difficulty and high costs in seeking medical care [1]. - The reform emphasizes city-level coordination and adheres to principles of "income-based expenditure, balanced revenue and expenditure, with slight surplus" [1]. Group 2: Payment Mechanism - The annual total payment amount for medical communities will be determined based on the average medical expenses over the previous three years, with adjustments for annual growth [2]. - A 3% annual guarantee fund and a 2% risk adjustment fund will be established within the total payment amount [2]. - Payments will be made monthly, with year-end settlements based on performance evaluations of medical services [3]. Group 3: Risk Sharing - A mechanism for shared responsibility regarding surplus and reasonable overspending will be established, with a risk adjustment fund covering initial overspending due to public health emergencies [4]. - The specific rules for surplus retention and overspending sharing will be developed by local medical insurance and health departments [4]. Group 4: Referral Mechanism - The reform includes the establishment of a dual-direction referral mechanism, where referrals within the medical community are treated as a single hospitalization, requiring only one deductible payment [5][6]. Group 5: Case Study - Yangxi Medical Community - Yangxi County, a pilot area for the reform, has successfully transitioned from a deficit to a surplus in its medical insurance fund, achieving a surplus of 36.47 million yuan in 2023, up from a deficit of 41 million yuan in 2018 [8][9]. - The county's medical community has implemented measures to reduce disease prevalence and medical expenses, thereby enhancing health management and service efficiency [8][9].
看病住院费用将推行“医保包干”
Nan Fang Du Shi Bao·2025-08-07 02:26