Strengthening medical insurance management mainly refers to cost control management
Strengthening medical insurance management mainly refers to cost control management. Generally the current practice includes the total amount prepaid, the overspending shared by the medical insurance organization and hospital, and the cost control according to disease type, project and patient quantity. The total payment control of basic medical care of this year has been fully implemented, generally adopting the composite payment method and combining the ways of payment according to disease type, project and patient quantity, which plays a role in reducing self-pay level of patients.
Secondly, promoting computerized management of prescriptions helps medical institutions strengthen internal supervision, what is more, helps medical insurance institutions supervise medical institutions and medical personnel, and also plays a role in reducing self-pay proportion of patients.
Thirdly, exploring the negotiation mechanism of innovative pharmaceutical products. Some critical patients now must use relatively expensive new drugs for clinic. Some places explore to conduct negotiation to lower prices of targeted drugs for partial tumors and some drugs essential to rare diseases and orphan diseases, to incorporate them in the payment scope of medical insurance to ensure treatment of those critical patients to the benefit of reducing cost. This point is one large aspect strengthening control of medical insurance cost.
