Core Viewpoint - The introduction of the DRG (Diagnosis-Related Groups) payment system is expected to significantly reduce over-medicalization in hospitals, but it also poses challenges for million medical insurance policies, potentially making them less effective for policyholders [6][12][44]. Group 1: Impact of DRG on Medical Practices - In 2022, a random check of 125 medical records in Huangshi City revealed that 113 cases involved unnecessary surgeries or violations of medical procedures, highlighting the prevalence of over-medicalization [3][5]. - The DRG system changes the hospital's profit model from itemized billing to a fixed payment per diagnosis, which encourages hospitals to control costs and reduce unnecessary treatments [10][11]. - Since the implementation of DRG, the average hospitalization costs have decreased, with employee insurance averaging 11,169 yuan and resident insurance averaging 7,295 yuan per hospitalization [13]. Group 2: Challenges for Million Medical Insurance - The DRG reform has made it more difficult for policyholders to meet the deductible threshold of million medical insurance, as hospitalization costs are now lower [12][20]. - Many existing million medical insurance products have a deductible of 10,000 yuan, which may not be reached under the new cost control measures, leading to potential non-reimbursement for policyholders [14][18]. - The insurance industry is facing a significant decline in premium income, with a notable drop of 28% in the premium for the flagship million medical insurance product from ZhongAn Insurance [28][29]. Group 3: Insurance Industry Response - In response to the challenges posed by DRG, insurance companies are adjusting their products by lowering deductibles and expanding coverage for out-of-pocket medications [30][31]. - New product iterations include options with zero deductibles and broader coverage for outpatient medications, aiming to enhance the practical value of million medical insurance [30][33]. - The insurance sector is also exploring the development of high-end medical insurance products that are less affected by DRG policies, providing an alternative for consumers [40][42]. Group 4: Future Outlook - Despite the challenges, million medical insurance still holds value for serious illnesses, as it provides significant reimbursement for high medical costs [19][44]. - The ongoing adjustments in the insurance market may lead to improved product offerings that better meet consumer needs in the context of DRG reforms [46].