According to statistics from a reporter from China Securities Journal, following the release of the "Three-Year Action Plan for the Reform of DRG/DIP Payment Methods" by the National Medical Security Administration, Anhui, Qinghai, Inner Mongolia, Hunan, Jiangxi, Gansu and other places have issued three-year actions for the reform of medical insurance payment. plan/implementation.

  Reform the spring breeze, listed companies have added a layout.

Guoxin Health has successively announced that it has won the bid for DRG/DIP information system projects; most of the DRG/DIP projects in Sichuan, Yunnan, Zhejiang and other regions undertaken by Jiuyuan Yinhai have passed the acceptance inspection and entered the actual payment settlement; Saili Medical announced that it has undertaken the construction of 4 national-level platforms , Informatization construction of 12 provincial/sub-provincial platforms.

The reform of medical insurance payment has entered the deep water area

  On January 6, the Anhui Provincial Medical Security Bureau issued the "Three-Year Action Plan for the Reform of DRG/DIP Payment Methods in Anhui Province", proposing that by the end of 2022, 17 co-ordination areas in the province will comprehensively carry out the reform of DRG/DIP payment methods to achieve full coverage in the co-ordination areas; By the end of 2023, all coordinating regions will basically achieve full coverage of eligible medical institutions, diseases, and medical insurance funds; by the end of 2024, a new unified medical insurance payment mechanism across the province will be basically established.

Newly added Bozhou City, Chizhou City and provincial direct medical insurance to carry out pilot work, start simulated payment by the end of 2022, and realize actual payment by the end of June 2023.

  On January 6, Nanjing Medical Insurance Bureau issued an announcement to formally implement the reform of DRG payment method, and announced the list of 36 disease groups, including esophagitis and gastroenteritis group; colonoscopy treatment operation group; diabetes, with complications or comorbidities group Wait.

Nanjing became the first version of the country's first version of the CHS-DRG grouping program and took the lead in using Chinese medicine groups.

In addition, the Nanjing Medical Insurance Bureau has developed a DRG area for the medical insurance high-speed railway, which dynamically displays more than 120 DRG operation index parameters according to different dimensions such as management level, institution level and time span, and presents Nanjing DRG in an all-weather, multi-dimensional, multi-level and refined manner. performance and quality.

  It is understood that DRG is paid by disease diagnosis-related groups. According to the patient's disease type, disease severity, treatment method and other factors, patients are divided into diagnosis-related groups with similar clinical symptoms and resource consumption, and the group is packaged and determined. Medicare payment standards.

DIP refers to payment by disease value. It uses big data to use the combination of "disease diagnosis + treatment" as a payment unit. The medical insurance department determines the payment standard for each disease according to the total amount of medical insurance funds that should be paid each year.

The basic principles of DIP disease score is the more serious disease, the greater the difficulty, the more consumption, the higher the resource consumption, the higher the score.

  According to industry insiders, DRG is based on clinical practice, and DIP is based on historical data for payment management.

The former is widely implemented around the world, but it involves grouping and requires higher basic conditions and professionalism.

In view of the backwardness of medical records and coding management in some central and western regions of my country, the international payment model cannot be copied.

At present, among the 101 pilot cities for the reform of payment methods announced by the National Medical Insurance Administration, there are 71 pilot cities for DIP and 30 pilot cities for DRG.

Listed company actively participates

  On January 10th, Saili Medical stated on the interactive platform that the company’s shareholding Jindou data currently occupies a leading position in the DRG/DIP pilot city market, and the number of pilot cities that have won bids is in the forefront. Provincial / Deputy Provincial Platform and Sanming, Shenzhen and other nearly 40 municipal level platform information construction.

  On the same day, Guoxin Health announced on the WeChat public account that the company won the bid for the "Professional Technical Service Project of Medical Service Management of Shenzhen Medical Security Bureau", providing quality control of medical insurance settlement list, localized grouping plan, payment standard calculation, medical institution operation monitoring and DRG and DIP dual-mode full-stack services such as macro decision analysis.

  Shenzhen Municipal Government procurement supervision network data shows that the national new health bidding price is 1.6 million yuan, lower than 209 million yuan in the second prize.

Previously, Guo Xin Health Winning "Ganzi State According to the Divination Fund (DIP) Information System Construction Service Procurement Project".

According to the Sichuan Provincial Government Procurement Network, the transaction price is 3.3218 million yuan. It is agreed that the construction of the DIP platform will be completed before June 30, 2022, and it will be officially launched on October 1, 2022. It will take the lead in including designated medical institutions at the state level Piencing payment.

  In addition to increasing the layout of medical insurance, a number of listed companies said that they also provided a series of DRG/DIP solutions for hospitals.

Donghua Software said that the company has launched hospital-side DRG/DIP products in more than 200 hospitals.

Jiuyuan Yinhai said that the company has completed the application of hospital-side DRG/DIP in nearly 100 hospitals and many medical complexes in 10 provinces. Most of the DRG/DIP projects currently under construction in Sichuan, Yunnan, Zhejiang and other regions have passed the acceptance and entered Actual payment settlement.

  Minsheng Securities believes that DRG/DIP, as a new digital and systematic payment method, can improve the overall efficiency of the system on the premise of saving resources of all parties, and achieve a win-win situation for hospitals, medical insurance, and patients.

In terms of the Medical Insurance Bureau, the construction of medical IT is in full swing, and the provincial-level units quickly cover all the overall planning areas.

Hospitals have sufficient motivation to promote the construction of DRG/DIP due to the needs of industry policies, cost control and performance appraisal.

It is estimated that the hospital will bring a market space of 19.216 billion yuan.

Earning problem

  A reporter from China Securities Journal observed that although listed companies have more power, they still face difficulties in making profits.

  On January 10, Seri Medical announced that the company is committed to providing medical institutions with a smart hospital lean management service plan that integrates SPD+CDSS (clinical decision-making system)+DRGs/DIP medical insurance fee control services.

However, the business transformation still needs investment and development cycle. The SPD business is still in the construction stage as a whole. At this stage, the overall gross profit margin is about 10%, which is lower than the original IVD business gross profit margin level. There is a risk that the company's overall gross profit margin will decline.

  Guoxin Health said in an institutional survey that the overall gross profit margin of Guoxin Health's digital medical insurance business in 2020 is negative, mainly because of the high degree of customization of the project, which usually involves complex medical, pharmacy, statistics and other fields. Relevant professionals to solve the problem, the labor cost is high.

It is expected that by the end of 2022, the company's digital medical insurance segment revenue cannot cover the total cost.

(Ni Mingya)