力争实现高效、可持续、获得感！解读·按病种付费3.0版有何调整？

Core Viewpoint - The National Healthcare Security Administration (NHSA) has been implementing the "Diagnosis-Related Group (DRG)" payment reform since 2019, which aims to enhance the efficiency of healthcare fund usage, ensure sustainable hospital development, and improve patient satisfaction. The 3.0 version of this payment model is expected to be released in 2026 [1][6]. Payment Reform Overview - The reform shifts the payment model from "fee-for-service" to "payment by diagnosis," meaning hospitals are compensated based on the diagnosis rather than the number of services provided [3][4]. - This change encourages hospitals to control costs and reduce unnecessary tests and treatments, as they receive a fixed payment for similar cases regardless of the actual expenses incurred [4][6]. Challenges and Issues - Some hospitals have reportedly imposed restrictions such as "no more than 15 days of hospitalization," leading to issues like premature discharges and inadequate treatment for complex cases [3][5]. - Experts highlight that the average length of stay is a key performance indicator for hospitals, which may lead to a focus on minimizing hospital stays rather than ensuring comprehensive patient care [5][6]. Future Adjustments and Goals - The upcoming 3.0 version of the DRG payment model is expected to introduce more refined grouping based on disease type, severity, and treatment methods, allowing for more precise payment standards [6][8]. - The NHSA aims to address the balance between efficient fund usage, sustainable hospital operations, and enhanced patient experiences through these adjustments [10]. Recommendations for Improvement - Experts suggest enhancing the service capabilities of primary care hospitals to manage minor illnesses locally while directing more severe cases to specialized hospitals [11]. - There is a call for improved reimbursement processes for patients seeking care across provinces and stricter regulation of hospital charging practices [11].