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 recent reforms in medical insurance payment methods, particularly the special single negotiation mechanism, aim to support the use of innovative drugs and medical devices, addressing concerns about high costs in medical institutions [1][3][4]. Group 1: Special Single Negotiation Mechanism - The special single negotiation mechanism is designed to provide reasonable compensation for medical services when the costs exceed three times the payment standard [2][4]. - The mechanism will be refined in conjunction with national policies supporting the development of innovative drugs and medical devices, indicating a commitment to support medical institutions in treating complex and critical patients [3][4]. - The number of cases eligible for special single negotiation should not exceed 5% of the total discharged cases under the DRG or DIP payment systems [4]. Group 2: Impact on Innovative Drugs - The reforms are expected to benefit drugs listed in the commercial health insurance innovative drug directory, particularly those with high clinical value and patient benefits [5][6]. - The introduction of the commercial health insurance innovative drug directory is anticipated to provide a framework for local authorities to evaluate and implement the special single negotiation policy effectively [5][7]. - Local governments, such as those in Hainan and Guangzhou, are developing their own innovative drug directories to enhance the support for innovative drugs and medical devices [8][9]. Group 3: Regional Initiatives - Regions with relatively abundant medical insurance funds, like Shanghai and Zhejiang, have already launched local supportive directories for innovative drugs and devices [8][10]. - The Zhejiang Medical Security Bureau has established a list of innovative medical technologies eligible for payment incentives, focusing on drugs that have recently entered the basic medical insurance directory [11][12]. - Shanghai has implemented a strategy to adjust payment standards for cases involving new technologies, allowing for full payment without a control ratio for high-cost cases [12].