赋能医疗机构高质量发展医保按病种付费新规出台

Core Viewpoint - The National Healthcare Security Administration (NHSA) has released the "Interim Measures for Medical Insurance Payment by Disease" aimed at reforming the medical insurance payment system to establish a unified, efficient, and standardized mechanism that supports the high-quality development of medical institutions [1] Summary by Relevant Sections Payment System Reform - The new measures focus on payment by disease, emphasizing the need for a comprehensive reform of the medical insurance payment methods [1] - The goal is to create a nationwide unified payment mechanism that is effective and collaborative [1] Budget Management - The measures stipulate strict total budget management, requiring reasonable expenditure budgeting to determine the total payment amount by disease [1] - It emphasizes the rigidity of the total budget [1] Grouping Scheme - The measures clarify the responsibilities for formulating and adjusting grouping schemes, including the framework, data support, and adjustment content [1] - Grouping schemes are to be adjusted every two years [1] Core Elements and Supporting Measures - The measures define key elements such as weight, rate, and payment standards, requiring collaboration between the NHSA and medical institutions to reach consensus [1] - It also standardizes supporting measures related to medical insurance payments, including special negotiations, advance payments, opinion collection, and data publication to enhance the scientific level of medical insurance payments [1]