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DRG改革3年省下56亿元
Xin Hua Ri Bao· 2025-04-06 19:04
Core Insights - The core viewpoint of the articles is the successful implementation of the DRG (Diagnosis-Related Group) payment reform in Nanjing, which has led to a win-win situation for the healthcare system, hospitals, and patients through improved data transparency and management [1][4]. Group 1: DRG Payment Reform - All eligible medical institutions in Nanjing have participated in the DRG payment reform, which is expected to reduce the actual expenditure of the medical insurance fund from projected amounts [1]. - The forecasted medical insurance fund amounts for 2022 to 2024 are 10.1 billion, 12.7 billion, and 12.8 billion yuan, while the actual amounts were 8.8 billion, 10.7 billion, and 10.5 billion yuan, indicating a reduction of 1.3 billion, 2 billion, and 2.3 billion yuan respectively [1]. - The average medical expenses for insured patients are projected to decrease from 14,204 yuan in 2022 to 13,255 yuan in 2024, with personal burdens decreasing by 488 yuan, 161 yuan, and 124 yuan over the same period [1]. Group 2: Data Transparency and Monitoring - Nanjing's medical insurance bureau has expanded the data disclosure from 45 indicators to an additional 30 local indicators, enhancing the monitoring of fund risks and business operations [2]. - The frequency of data publication has increased from once a month to real-time, monthly, quarterly, semi-annual, and annual disclosures, allowing for more timely insights into healthcare operations [2]. - The "Medical Insurance High-speed Rail" mobile cloud platform, initiated four years ago, has integrated over 4,000 doctors and 2,148 designated medical institutions, accumulating a total of 66.764 billion data entries [3]. Group 3: Impact on Hospital Management - The intelligent monitoring and early warning functions of the "Medical Insurance High-speed Rail" platform have enabled hospitals to identify potential risk points and take proactive measures [3]. - Since the launch of the DRG section and outpatient monitoring module in 2022, hospitals have utilized feedback from the platform to enhance their internal performance assessments and improve patient experience [3]. - The ongoing commitment to data transparency and management is expected to assist hospital managers in making informed decisions, thereby enhancing the overall efficiency of the healthcare system in Nanjing [4].