医药生物行业周报：DRG/DIP 2.0版分组方案出炉，特例单议机制支持新药、新技术合理应用
Shanghai Securities·2024-07-29 08:00

Investment Rating - The industry investment rating is maintained at "Overweight" [6] Core Viewpoints - The new DRG/DIP 2.0 grouping scheme released by the National Healthcare Security Administration is more aligned with clinical realities, enhancing the grouping of high-resource-consuming categories. The core grouping now includes 409 groups, an increase of 33 from the previous version, and the detailed grouping has 634 groups, an increase of 6 [4][5] - The new scheme allows for a quantitative approach to special case negotiations, supporting the reasonable application of new drugs and technologies. Medical institutions can apply for separate reviews for cases that do not fit the DRG/DIP payment standards, with a cap on special case negotiations not exceeding 5% of total DRG discharges or 5‰ of total DIP discharges [4][5] - The efficiency of medical insurance fund settlement is expected to improve, with a prepayment system alleviating financial pressure on medical institutions. Regions are encouraged to complete annual fund settlement by June 30 of the following year and to implement a prepayment mechanism for designated medical institutions [4][5] - The 2.0 version is set to be implemented in 2025, with regions that have already adopted DRG/DIP payments required to prepare for the transition by December 31, 2024 [4][5] - The report emphasizes that medical institutions should not use DRG/DIP payment standards as limits for assessing medical staff or linking to performance distribution indicators [4][5] Summary by Sections - The report highlights that since 2019, over 90% of regions have adopted DRG/DIP payment methods, with 26 provinces achieving full coverage. The 2.0 version addresses previous inaccuracies and clinical relevance issues, supporting the treatment of complex cases and the application of new drugs and technologies [4][5] - The report suggests focusing on innovative drug companies such as Ailis, Kangfang Biotech, Kelun Botai, Maiwei Biotech, and others for investment opportunities [6]