Core Viewpoint - The article discusses the implementation of a new payment reform in China's healthcare system, focusing on a disease-based payment model to enhance efficiency and control costs in medical services [1][2]. Summary by Sections Payment Reform Overview - The National Healthcare Security Administration (NHSA) has introduced the "Interim Measures for the Management of Disease-Based Payment" to promote a multi-faceted payment reform primarily based on disease categories [1]. - The new measures will establish a dynamic adjustment mechanism for disease grouping schemes, with adjustments occurring approximately every two years [1][2]. Disease-Based Payment Mechanism - Disease-based payment involves grouping diseases or calculating values to implement a "bundled payment" system for medical institutions [2]. - The NHSA has been actively promoting disease-based payment for inpatient medical expenses, focusing on two pilot projects: Diagnosis-Related Groups (DRG) and Disease-Based Value Payment (DIP) [2]. - Adjustments to the DRG grouping scheme will maintain stability in major diagnostic categories while focusing on core and detailed subgroup adjustments [2]. Key Policies and Measures - The new measures clarify policies, key technologies, core elements, and supporting measures related to disease-based payment, emphasizing rigid total budget management [2]. - The NHSA will incorporate disease-based payment requirements into agreement management, enhance monitoring and evaluation of reform effectiveness, and strengthen fund supervision [2]. Special Case Mechanism - A "special case negotiation" mechanism has been established to support medical institutions in treating complex and severe patients, allowing for reasonable use of new drugs and technologies [3]. - Cases eligible for special negotiation include those with long hospital stays, high resource consumption, and complex conditions that do not fit standard payment models [3]. Impact on Medical Institutions - The shift from fee-for-service to disease-based payment encourages medical institutions to control costs while still generating revenue [5]. - Institutions can apply for special case negotiations for patients requiring extensive resources or new treatments, ensuring adequate care [5]. Impact on Patients - The reform does not alter the patient discharge settlement experience, and patients may see a reduction in out-of-pocket expenses due to fewer unnecessary medical services [6]. - The NHSA has not imposed restrictions on hospital stays, and any coercive practices by medical institutions regarding discharge will be strictly addressed [6].

Core Viewpoint - The National Healthcare Security Administration (NHSA) has released the "Interim Measures for Disease-Specific Payment Management," aiming to reform 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 disease-specific payment as a key aspect of the medical insurance payment reform [1] - The goal is to create a nationwide unified payment mechanism that is effective and collaborative [1] Budget Management - The measures emphasize the importance of total budget management, requiring reasonable expenditure budget preparation and establishing a rigid total for disease-specific payments [1] Grouping Scheme - The measures specify the formulation and adjustment of grouping schemes, detailing the responsible parties, framework, supporting data, and adjustment content, with a principle of biennial adjustments [1] Core Elements and Supporting Measures - The measures clarify the definitions of key elements such as weight, rate, and payment standards, mandating that the NHSA collaborates with medical institutions to reach consensus [1] - It also standardizes supporting measures related to medical insurance payments, including special case negotiations, advance payments, opinion collection, negotiation, and data publication to enhance the scientific level of medical insurance payments [1]