Policy Developments - The National Healthcare Security Administration (NHSA) has issued the "Interim Measures for the Management of Disease-Specific Payment in Medical Security" to promote a multi-faceted payment reform focused on disease-specific payments [2] - The measures consist of eight chapters and thirty-nine articles, emphasizing budget management, grouping scheme formulation, and core elements and supporting measures [2][3] - The new regulations aim to enhance the scientific level of medical insurance payments and standardize the payment process [2] Drug and Device Approvals - Kehua Bio's syphilis antibody quality control product has received a medical device registration certificate, which will enhance the company's product line [5] - Haikang's new indication application for HSK39297 tablets has been accepted, targeting age-related macular degeneration and myasthenia gravis, indicating potential for effective treatment [6] Financial Reports - Leksin Medical reported a revenue of 521 million yuan for the first half of the year, a year-on-year increase of 4.57%, with a net profit of 42.29 million yuan, up 21.35% [8] - Gilead Sciences reported a revenue of 104 million yuan for the first half of the year, a significant increase of 111.4%, with a net loss of 87.95 million yuan, narrowing by 32.5% [9] Capital Market Activities - Yunnan Baiyao plans to acquire 100% of the equity of Juyitang for 660 million yuan to enhance its business layout and expand its market presence [11] - Kangzhong Medical intends to invest 20 million yuan to acquire a 6.67% stake in Shanghai Renyan Information Technology to support its strategic transformation [12] Industry Events - Ji Xunming has been appointed as the president of the Chinese Academy of Medical Sciences and Peking Union Medical College, indicating a leadership change in a key medical institution [14] - The National Health Commission and the Ministry of Education are urging Beijing Union Medical College to rectify issues related to its "4+4" pilot program, focusing on stricter management and oversight [15] Public Sentiment Alerts - Zhongke Investment plans to reduce its stake in Nanwei Medical by up to 2%, indicating potential changes in shareholder structure [18] - Sichuan Medical received a notice from the Hangzhou Public Security Bureau regarding evidence collection related to a fraud investigation, highlighting ongoing legal scrutiny [20]

Core Viewpoint - The National Healthcare Security Administration (NHSA) has issued a temporary measure to manage disease-based payment systems, aiming to enhance the standardization of medical insurance payments across all regions in China [1][2]. Group 1: Payment Reform - The traditional payment method in China was fee-for-service, which often led to excessive medical practices such as over-prescribing and unnecessary tests [2]. - Since 2019, the NHSA has been promoting a "disease-based payment" reform, where payments are bundled based on historical data and patient conditions, shifting the focus from quantity of services to cost control [2][4]. - As of the end of 2024, over 90% of hospital discharges will be covered under the disease-based payment system [5]. Group 2: Impact on Medical Institutions - The reform has led to more standardized medical practices, reduced time and costs, and shorter average hospital stays [4]. - Medical institutions can apply for special cases for patients with long hospital stays or high resource consumption, allowing for project-based payments if necessary [4][5]. - Nearly 60% of tertiary public hospitals have adopted "day surgery," allowing patients to complete procedures within 24 hours, thus improving bed turnover and reducing costs [7]. Group 3: Patient Experience - The disease-based payment system reduces the financial burden on patients and encourages hospitals to control costs and standardize treatment [7]. - Patients who previously required hospitalization for simple procedures can now receive treatment as day surgeries, which are reimbursed at the same rate as inpatient care [7][9]. - In Shandong, patients can undergo simple surgeries and be discharged within 24 hours, significantly reducing hospital stay duration and costs by approximately 30% [11].

Core Viewpoint - The National Healthcare Security Administration (NHSA) has issued the "Interim Measures for Disease-Specific Payment Management," aiming to guide local governments in advancing the reform of disease-specific payment systems, particularly focusing on Diagnosis-Related Groups (DRG) and Disease-Specific Payment (DIP) methods [1][2]. Summary by Relevant Sections Reform Background - The DRG payment system was first implemented in China in 2008, with a nationwide rollout of a comprehensive DRG system starting in 2018. The DIP pilot began in 2020, marking a significant shift towards a unified national payment system [2]. - The NHSA has been actively promoting payment reform to enhance the efficiency of medical fund usage and control costs within healthcare institutions [2]. Key Features of the New Measures - The new measures emphasize three main areas: 1. Total budget management, requiring reasonable budget preparation and emphasizing the rigidity of total budget limits. 2. Standardization of grouping schemes, including clear guidelines on the formulation and adjustment of grouping schemes, which should be revised every two years. 3. Clarification of core elements and supporting measures, ensuring that key factors like weight, rate, and payment standards are well-defined [3][4]. Implementation and Adjustments - The NHSA is responsible for the formulation and adjustment of grouping schemes, while local authorities can tailor DRG subdivisions to local conditions. The grouping framework includes major diagnostic categories, core groups, and detailed subdivisions [3][4]. - Adjustments to the DRG grouping scheme will focus on maintaining stability in major diagnostic categories while allowing for changes in core and detailed groups, with a two-year adjustment cycle [4]. Transparency and Support Mechanisms - The new measures aim to enhance transparency in total budget management and provide clearer technical standards for grouping and adjustments, addressing concerns from healthcare institutions [5]. - The NHSA has also introduced supporting mechanisms, including prepayment of medical funds to qualifying institutions, which has exceeded 1.7 trillion yuan as of July 2024, and reduced settlement cycles for medical institutions [6]. Training and Capacity Building - The NHSA emphasizes the need for local healthcare departments to improve policies and supporting mechanisms, monitor reform effectiveness, and provide training for staff involved in the implementation of disease-specific payment systems [7].

Core Insights - The reform of medical insurance payment methods in China has achieved initial success, with a focus on sustainable funds, improved medical quality, and benefits for the public [2][3] - The current payment methods include Diagnosis-Related Group (DRG) and Diagnosis-Intervention Package (DIP), with 191 and 200 regions implementing these respectively, achieving 95% disease coverage and 80% fund coverage [2][3] Group 1: Reform Achievements - As of now, 24 provinces have implemented real-time settlement of medical insurance funds, covering 246,700 designated medical institutions and disbursing 165.7 billion yuan, alleviating hospital operational pressure [3][6] - The prepayment system for medical insurance funds has been effectively implemented, with a total prepayment scale of 72.3 billion yuan in the first quarter of 2025, helping public hospitals reduce financial burdens [3][6] Group 2: Challenges and Future Directions - The reform faces challenges such as the contradiction between rising medical costs and payment management, the need for quality improvement, and insufficient collaboration among stakeholders [2][3] - Future efforts will focus on building a diversified payment system and continuing to deepen the medical insurance payment reform [3][8] Group 3: Practical Insights from Experts - Experts suggest that hospitals should establish a refined operational management system centered on disease categories, integrating payment methods into daily operations to enhance management efficiency [5][6] - The Shanghai model emphasizes a flexible fee rate system and the establishment of a monitoring platform to support comprehensive management and ensure mutual benefits for medical institutions, insured patients, and the medical insurance fund [7][8]