央视网消息：国家医保局自2019年起，推行"按病种付费"支付方式改革，如今这项改革在持续进行中，"按病种付费"已覆盖所有医保统筹地 区。2026年，国家医保局将发布按病种付费3.0版分组方案，力争实现医保基金高效使用、医院可持续发展与患者获得感提升的多重目标。 "医保患者住院不超过15天"是真的吗？ 按病种付费改的不是患者的医保待遇，而是医保基金和医院之间的结算方式，就是将过去的"按项目付费"改为"按病种付费"，从"为过程买 单"变成"为结果买单"。但是在推行过程中，一些地方出现了医保患者年底住院难、重症患者分解住院等现象，还有些医院规定"单次住院不超 过15天"。为什么会出现这些现象？又有怎样的解决方式？ 自2019年起，国家医保局持续推行"按病种付费"，病情相似的同一组住院病例，不管医院花了多少钱，医保都按同一个标准"打包给钱"。医院 从"多开项目获得收益"，转变为"控制成本也能获得收入"，倒逼医院减少不必要的检查与用药。 但是专家指出，如果医保部门和医疗机构没有建立协同机制，就可能出现医院为控制成本，推诿病情复杂、费用超标的患者，或者是减少必要 的医疗服务，以及分解住院，让患者出院再入院的问题发生。近年 ...

Core Insights - The article discusses the ongoing reform of the "Diagnosis-Related Group (DRG)" payment system in China's healthcare, which aims to improve the efficiency of medical insurance fund usage and enhance patient experience [1][4][13] Payment Reform Overview - The traditional payment method was based on "fee-for-service," which incentivized excessive medical practices. The DRG system groups similar cases and sets a unified payment standard based on historical data, promoting rational use of medical insurance funds [1][2] - The DRG payment reform has been implemented since 2019 and is set to evolve with the release of version 3.0 in 2026, aiming for better fund utilization, hospital sustainability, and improved patient satisfaction [1][13] Challenges and Solutions - Issues have arisen during the implementation, such as hospitals limiting patient stays to under 15 days and pushing patients out prematurely to control costs. This has led to concerns about the quality of care for complex cases [2][3] - Experts suggest that hospitals should collaborate with medical insurance departments to avoid cost-cutting measures that compromise patient care. A mechanism for special cases has been established in some regions to address these challenges [3][5] Case Study: Anyang City - Anyang City has implemented a unique approach where cases exceeding 60 days or requiring special treatment are settled separately, allowing hospitals to manage costs without compromising care [4][6] - In 2024, Anyang reported over 13,000 special cases with a total expenditure of 266 million yuan, demonstrating the effectiveness of this model in preventing premature discharges [6][7] Financial Outcomes - The reform has led to a surplus in the medical insurance fund, with Anyang's fund showing a balance after years of deficits. The total expenditure for hospitals has increased, and the average hospitalization cost has decreased significantly [7][9] - The average hospitalization cost in Anyang dropped from over 11,100 yuan in 2020 to 9,780 yuan in 2024, a reduction of 11.99% [9][10] Day Surgery Implementation - The introduction of "day surgery" has accelerated bed turnover and reduced costs, with nearly 60% of tertiary hospitals adopting this practice. Patients can now complete procedures within 24 hours, leading to lower expenses and resource optimization [10][12] - The average hospitalization duration has decreased, and personal out-of-pocket expenses have also declined, indicating a positive trend in patient care and cost management [12][13] Future Directions - The upcoming version 3.0 of the DRG payment system will focus on more refined classifications and regular updates to payment standards, ensuring that the system adapts to changes in medical practices and technologies [13][14] - Enhancing the service capacity of primary healthcare institutions and facilitating cross-province reimbursement for patients are essential steps for future improvements in the healthcare system [14]

据央视新闻，12月13日，全国医疗保障工作会议在北京召开，国家医保局在会议上发布多项数据和措 施。 2026年，国家医保局将发布按病种付费3.0版分组方案。全面推行按季或按月特例单议评审，支持新药 耗新技术临床使用和疑难重症救治。加大医保基金预付力度，全面推进医保基金即时结算，探索按季度 清算。全面完成40批立项指南编制工作，实现医疗服务价格项目全国基本统一。 力争基本实现政策范围内分娩个人"无自付" 国家医保局表示，为积极适应人口发展战略，2026年将持续推动生育保险和长期护理保险发展，力争全 国基本实现政策范围内分娩个人"无自付"。 我国建立完善居民医保高血压、糖尿病"两病"门诊用药保障机制。健全重特大疾病医疗保险和救助制 度。5年来大病保险累计惠及超3.4亿人次。建立完善防范化解因病致贫返贫风险的长效机制，加强困难 群众就医服务管理，支持慈善等社会力量参与医疗救助，医疗救助惠及11.89亿人次，农村困难群众政 策范围内报销比例超90%。 医保大力支持医疗机构发展 2025年我国持续深化医保支付方式改革，促进医疗卫生事业和医药行业发展，按病种付费从试点起步实 现全面覆盖。 2025年，国家医保局制定实施按 ...

Policy Developments - The National Healthcare Security Administration (NHSA) has issued the "Interim Measures for the Management of Disease-Specific Payment" to promote a multi-faceted healthcare payment reform focused on disease-specific payments [1][2] - The framework consists of eight chapters and thirty-nine articles, emphasizing budget management, grouping scheme formulation, and core elements and supporting measures [2][3] - The introduction of this measure is expected to enhance the standardization of disease-specific payment systems and improve the efficiency of healthcare fund utilization [3] Drug and Medical 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 [4] - Haikang Pharmaceutical's new indication application for HSK39297 tablets has been accepted, targeting age-related macular degeneration and generalized myasthenia gravis [5] 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% [6] - 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% [7] Mergers and Acquisitions - Yunnan Baiyao plans to acquire 100% equity of Juyitang Pharmaceutical for 660 million yuan to enhance its business layout and expand its market presence [8] - Kangzhong Medical intends to invest 20 million yuan to acquire a 6.67% stake in Shanghai Renyan Information Technology to support its strategic transformation [9] Industry Events - Ji Xunming has been appointed as the president of the Chinese Academy of Medical Sciences and Peking Union Medical College [10] - 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 [11] Other Developments - Buchang Pharmaceutical's subsidiary plans to sign a technology transfer contract with Shandong University of Traditional Chinese Medicine for 15 million yuan [12] - Zhongke Investment plans to reduce its stake in Nanwei Medical by up to 2% due to funding needs [13] - Sichuan Medical Technology has received a notice from the Hangzhou Public Security Bureau regarding evidence collection related to a securities fraud investigation [14]

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]