DRG/DIP新政出台：医保支付方式改革如何走向提质增效？

Core Viewpoint - The National Healthcare Security Administration (NHSA) has issued the "Interim Measures for Disease-Specific Payment Management," aiming to guide local governments in advancing the reform of disease-specific payment systems, particularly focusing on Diagnosis-Related Groups (DRG) and Disease-Specific Payment (DIP) methods [1][2]. Summary by Relevant Sections Reform Background - The DRG payment system was first implemented in China in 2008, with a nationwide rollout of a comprehensive DRG system starting in 2018. The DIP pilot began in 2020, marking a significant shift towards a unified national payment system [2]. - The NHSA has been actively promoting payment reform to enhance the efficiency of medical fund usage and control costs within healthcare institutions [2]. Key Features of the New Measures - The new measures emphasize three main areas: 1. Total budget management, requiring reasonable budget preparation and emphasizing the rigidity of total budget limits. 2. Standardization of grouping schemes, including clear guidelines on the formulation and adjustment of grouping schemes, which should be revised every two years. 3. Clarification of core elements and supporting measures, ensuring that key factors like weight, rate, and payment standards are well-defined [3][4]. Implementation and Adjustments - The NHSA is responsible for the formulation and adjustment of grouping schemes, while local authorities can tailor DRG subdivisions to local conditions. The grouping framework includes major diagnostic categories, core groups, and detailed subdivisions [3][4]. - Adjustments to the DRG grouping scheme will focus on maintaining stability in major diagnostic categories while allowing for changes in core and detailed groups, with a two-year adjustment cycle [4]. Transparency and Support Mechanisms - The new measures aim to enhance transparency in total budget management and provide clearer technical standards for grouping and adjustments, addressing concerns from healthcare institutions [5]. - The NHSA has also introduced supporting mechanisms, including prepayment of medical funds to qualifying institutions, which has exceeded 1.7 trillion yuan as of July 2024, and reduced settlement cycles for medical institutions [6]. Training and Capacity Building - The NHSA emphasizes the need for local healthcare departments to improve policies and supporting mechanisms, monitor reform effectiveness, and provide training for staff involved in the implementation of disease-specific payment systems [7].