两年一次！医保“打包付费”将实行动态调整

Core Viewpoint - The new regulations from the National Medical Insurance Administration (NMIA) establish a dynamic adjustment mechanism for disease-based payment schemes, which will be adjusted every two years to align with clinical developments [1][2]. Group 1: Payment Mechanism - The disease-based payment system includes two forms: Diagnosis-Related Group (DRG) payment and Disease Indicator Point (DIP) payment [1]. - The DRG grouping will focus on adjusting core and detailed groups while maintaining stability in major diagnostic categories [1]. - The DIP disease library adjustments will emphasize core and comprehensive disease types [1]. Group 2: Special Case Mechanism - The new regulations introduce a separate section for the "special case single negotiation" mechanism, allowing for cases that are not suitable for standard disease payment, such as long hospital stays or complex critical conditions [2]. - The NMIA aims to streamline the reporting process for special cases, enhancing efficiency and reducing the complexity of required documentation [2]. - This reflects the NMIA's commitment to support medical institutions in the rational use of new drugs and technologies for treating complex patients [2]. Group 3: Historical Context - The pilot reform of the disease-based payment system was initiated by the NMIA in 2019 and has since covered all coordinated areas [3].