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].

Core Viewpoint - The National Healthcare Security Administration (NHSA) has released the "Interim Measures for Medical Insurance Payment by Disease" aimed at reforming the medical insurance payment system to establish a unified, efficient, and standardized mechanism that supports the high-quality development of medical institutions [1] Summary by Relevant Sections Payment System Reform - The new measures focus on payment by disease, emphasizing the need for a comprehensive reform of the medical insurance payment methods [1] - The goal is to create a nationwide unified payment mechanism that is effective and collaborative [1] Budget Management - The measures stipulate strict total budget management, requiring reasonable expenditure budgeting to determine the total payment amount by disease [1] - It emphasizes the rigidity of the total budget [1] Grouping Scheme - The measures clarify the responsibilities for formulating and adjusting grouping schemes, including the framework, data support, and adjustment content [1] - Grouping schemes are to be adjusted every two years [1] Core Elements and Supporting Measures - The measures define key elements such as weight, rate, and payment standards, requiring collaboration between the NHSA and medical institutions to reach consensus [1] - It also standardizes supporting measures related to medical insurance payments, including special negotiations, advance payments, opinion collection, and data publication to enhance the scientific level of medical insurance payments [1]