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按病种付费!国家医保局正式印发
Ren Min Ri Bao·2025-08-19 06:14

Core Viewpoint - The National Healthcare Security Administration (NHSA) has officially issued the "Interim Measures for the Management of Disease-Specific Payment in Medical Insurance," aiming to reform the payment system primarily based on disease categories, establishing a dynamic adjustment mechanism for disease grouping schemes every two years [1] Summary by Relevant Sections Payment Reform - The new payment method involves grouping diseases or calculating scores to implement "bundled payments" to medical institutions, requiring dynamic adjustments to adapt to clinical changes due to rapid advancements in medical technology [1] - The NHSA has been promoting disease-specific payment for inpatient medical expenses, conducting pilot programs for Diagnosis-Related Groups (DRG) and Disease-Specific Payment (DIP) [1][5] Key Policies and Mechanisms - The "Interim Measures" clarify policies, key technologies, core elements, and supporting measures related to disease-specific payments, emphasizing rigid total budget management and the need for reasonable expenditure budgeting [1] - The measures also incorporate requirements for disease-specific payments into agreement management, enhance monitoring and evaluation of reform effectiveness, and strengthen fund supervision [1] Special Case Payment Mechanism - A dedicated section in the measures supports medical institutions in treating complex and severe patients, allowing for a "special case single negotiation" mechanism for cases that are not suitable for standard disease payment [2][5] - Cases eligible for special negotiation include those with long hospital stays, high resource consumption, and the use of new drugs or technologies [2] Impact on Patients and Institutions - The shift from itemized payments to disease-specific payments aims to reduce unnecessary medical services, potentially lowering the out-of-pocket expenses for patients [6] - The NHSA has stated that there are no restrictions on hospital stays, and any coercive practices by medical institutions to discharge patients prematurely will be strictly addressed [6]