The release of item guide is an important content of deepening the reform of medical service prices,and it is also a major measure to unify and standardize the price of medical services.Comprehensive examination items are widely grasped and applied by the majority of hospitals and medical personnel,the degree of service homogenization is relatively high,the frequency of occurrence is high,and it plays a key role in the medical service price system and service income.On the basis of the preparation ideas,framework structure design,item elements and characteristics of the comprehensive examination item initiation guide,it reviews the main changes in the establishment of the comprehensive examination item initiation guide price item,and puts forward suggestions to accelerate the implementation of the comprehensive examination item initiation guide:promoting the docking pricing and standardized implementation of the comprehensive examination item initiation guide,and starting the dynamic adjustment of the price of diagnostic items according to the trigger mechanism.

With the implementation of the medical service price item guidelines in various places,it is particularly urgent to follow up the coordinated policies of consumables that can be charged separately and their medical insurance catalog access and payment management.On the basis of reviewing the management policy of medical consumables charge and medical insurance catalogue,it introduces the practice of typical provinces,including making a catalogue list of consumables that can be charged separately to patients or forming a negative list of consumables based on basic consumption;formulating a unified payment management plan for medical consumables and a catalogue of medical consumables for medical insurance in the province;innovative medical consumables clinical application item fees and medical insurance payment policy coordination.The practice of typical provinces has implications for other regions to standardize consumables charges,medical insurance catalog access and payment:combing and screening,standardizing and integrating the content of price items in different places to form a list of consumables that can be separately charged;clearly defining the scope of access and meet the conditions,and classifying the consumables that can be charged separately into the medical insurance catalogue management according to the procedures.

Based on the price control of medical service items,medical insurance realizes the total cost control of medical services through the reform of payment methods.It analyzes the conflicts between the medical service price formation and payment based on DRG/DIP:measuring the medical insurance payment standard according to the historical average case cost rather than the diagnosis and treatment cost,and continuing the unreasonable price comparison relationship of items;new technologies,special medical service cases and DRG/DIP payment are not well connected,which hinders the demand for high quality and high price.It sorts out the linking practices of new medical service items and the implementation of market-regulated prices for non-basic medical service items and medical insurance payment,and obtains the enlightenment of other regions in promoting the formation of medical service price classification and the coordination of medical insurance DRG/DIP payment:fully applies cost information to the formation of reasonable medical service prices and the formulation of payment standards for patient groups(diseases);combines real-world data and health technology assessments to aid innovative medical technology pricing and payment access decisions;improves the inclusion standard,declaration procedure,review process and settlement method of DRG/DIP new technology special case;excludes the costs of eligible special medical care cases from the DRG/DIP payment criteria and fee settlement.

The release of the medical service price item guide is an important content of deepening the reform of medical service price,and is also a major measure to unify and standardize the medical service price item.Taking the Nursing Medical Service Price Item Proposal Guide(hereinafter referred to as the Nursing item Proposal Guide)as an example,it introduces the preparation ideas,framework structure design and item element changes of the nursing item proposal guide,sorts out the progress of docking and implementation of the Nursing Item Proposal Guide in typical provinces,and makes comparisons to obtain inspiration for accelerating the implementation of the item proposal guide in other regions:ensure the participation of clinical and price experts,mapping old and new items and integrating elements according to item guidelines;comprehensive use of cost pricing,reference pricing and value pricing,check and standardize the integrated item price;to standardize the integration of new item price adjustment and medical insurance payment policy coordination,forming a positive superposition effect;make a list of consumables that can be charged separately,and do a good job in the connection between product registration and price medical insurance policies;strengthen publicity and training,update information systems,monitor service volume,and track the effect of price policy implementation.

In the implementation process,the current medical service price item standard faces the facts,including disconnection between item establishment and clinical improvement innovation,disconnection from the masses'demand and disconnection from price management needs.The compilation of the guidelines for the establishment of medical service price items marks that the unified standardization of national medical service price items has entered the"fast lane".It reviews the policy requirements to promote the standardization and unification of the current medical service price items by compiling up item guidelines in batches,analyze the framework structure of the medical service price item guidelines,and studies the main changes of the medical service price item guidelines:integrating stock,compatible improvement,and supporting innovation.The policy suggestions to accelerate the implementation and application of the medical service price item guide include:according to the item guidelines,determine the mapping relationship between old and new items,standardize and integrate the current price items,and stop the original items;carry out cost investigation and calculation,weighted average according to the service volume,shift the price of old items,and approve the price of new items;guide public hospitals to implement item guidelines,track price implementation,monitor service number,and strengthen charge supervision.

By the end of 2024,the National Healthcare Security Administration has compiled a guide for the establishment of medical service price items covering most disciplines,and basically completed the top-level design of standardization and standardization of national medical service price items.On the basis of sorting out the ideas for the preparation of the for the medical service price item setting guidelines,and combining the practice of docking and implementing the compilation guidelines for the price items setting in typical provinces,it analyzes the impact of the docking and implementation of the item setting guidelines on medical care,medical insurance and patients and the coping strategies:clarifying the boundaries of technical specifications and price items,reforming compatible with technological improvements according to the item guidelines,and supporting major innovations;carrying out price and cost investigation of sample hospitals,scientifically and reasonably approving the integrated item price according to the item guidelines;item guidelines better reflecting the degree of operational risk,technical difficulty,labor value,optimizing the income structure of the hospital;standardizing items with item setting guidelines,promoting transparent and reasonable fees,and making patient payments more clear.

The medical service price is an important source for public hospitals to compensate the cost of medical service.There are many kinds of diseases and complicated treatment plan.The price formation should reflect the characteristics of medical service.On the basis of reviewing the policy of medical service price classification formation and combining with the practice of medical service price classification formation in typical areas,it analyzes the influencing factors and mechanism of price formation,and obtains the enlightenment for other regions to improve the medical service price formation mechanism:cost pricing,value pricing and reference pricing methods reflect the value of technical labor and reasonable price comparison relationship;distinguish the types and disciplines of medical service items,explore the same price in the same city,high quality and high price,and promote hierarchical diagnosis and treatment;build an intelligent cost and price management platform to promote the coordination of medical service prices and regional economic development level.

The medical service price is an important source for public hospitals to compensate the cost of medical service.There are many kinds of diseases and complicated treatment plan.The price formation should reflect the characteristics of medical service.On the basis of reviewing the policy of medical service price classification formation and combining with the practice of medical service price classification formation in typical areas,it analyzes the influencing factors and mechanism of price formation,and obtains the enlightenment for other regions to improve the medical service price formation mechanism:cost pricing,value pricing and reference pricing methods reflect the value of technical labor and reasonable price comparison relationship;distinguish the types and disciplines of medical service items,explore the same price in the same city,high quality and high price,and promote hierarchical diagnosis and treatment;build an intelligent cost and price management platform to promote the coordination of medical service prices and regional economic development level.

The release of the medical service price item guide is an important content of deepening the reform of medical service price,and is also a major measure to unify and standardize the medical service price item.Taking the Nursing Medical Service Price Item Proposal Guide(hereinafter referred to as the Nursing item Proposal Guide)as an example,it introduces the preparation ideas,framework structure design and item element changes of the nursing item proposal guide,sorts out the progress of docking and implementation of the Nursing Item Proposal Guide in typical provinces,and makes comparisons to obtain inspiration for accelerating the implementation of the item proposal guide in other regions:ensure the participation of clinical and price experts,mapping old and new items and integrating elements according to item guidelines;comprehensive use of cost pricing,reference pricing and value pricing,check and standardize the integrated item price;to standardize the integration of new item price adjustment and medical insurance payment policy coordination,forming a positive superposition effect;make a list of consumables that can be charged separately,and do a good job in the connection between product registration and price medical insurance policies;strengthen publicity and training,update information systems,monitor service volume,and track the effect of price policy implementation.

Based on the price control of medical service items,medical insurance realizes the total cost control of medical services through the reform of payment methods.It analyzes the conflicts between the medical service price formation and payment based on DRG/DIP:measuring the medical insurance payment standard according to the historical average case cost rather than the diagnosis and treatment cost,and continuing the unreasonable price comparison relationship of items;new technologies,special medical service cases and DRG/DIP payment are not well connected,which hinders the demand for high quality and high price.It sorts out the linking practices of new medical service items and the implementation of market-regulated prices for non-basic medical service items and medical insurance payment,and obtains the enlightenment of other regions in promoting the formation of medical service price classification and the coordination of medical insurance DRG/DIP payment:fully applies cost information to the formation of reasonable medical service prices and the formulation of payment standards for patient groups(diseases);combines real-world data and health technology assessments to aid innovative medical technology pricing and payment access decisions;improves the inclusion standard,declaration procedure,review process and settlement method of DRG/DIP new technology special case;excludes the costs of eligible special medical care cases from the DRG/DIP payment criteria and fee settlement.