Core Insights - The reform of medical insurance payment methods in China has achieved initial success, with a focus on sustainable funds, improved medical quality, and benefits for the public [2][3] - The current payment methods include Diagnosis-Related Group (DRG) and Diagnosis-Intervention Package (DIP), with 191 and 200 regions implementing these respectively, achieving 95% disease coverage and 80% fund coverage [2][3] Group 1: Reform Achievements - As of now, 24 provinces have implemented real-time settlement of medical insurance funds, covering 246,700 designated medical institutions and disbursing 165.7 billion yuan, alleviating hospital operational pressure [3][6] - The prepayment system for medical insurance funds has been effectively implemented, with a total prepayment scale of 72.3 billion yuan in the first quarter of 2025, helping public hospitals reduce financial burdens [3][6] Group 2: Challenges and Future Directions - The reform faces challenges such as the contradiction between rising medical costs and payment management, the need for quality improvement, and insufficient collaboration among stakeholders [2][3] - Future efforts will focus on building a diversified payment system and continuing to deepen the medical insurance payment reform [3][8] Group 3: Practical Insights from Experts - Experts suggest that hospitals should establish a refined operational management system centered on disease categories, integrating payment methods into daily operations to enhance management efficiency [5][6] - The Shanghai model emphasizes a flexible fee rate system and the establishment of a monitoring platform to support comprehensive management and ensure mutual benefits for medical institutions, insured patients, and the medical insurance fund [7][8]
723亿元预付探路全覆盖,医保支付改革再破局
Hua Xia Shi Bao·2025-04-18 13:58