Core Insights - The National Healthcare Security Administration (NHSA) has been implementing the "Diagnosis-Related Group (DRG)" payment reform since 2019, which has now covered all medical insurance coordination areas in China [1] - The DRG payment model aims to standardize the use of medical insurance funds by grouping similar inpatient cases and establishing a unified payment standard based on historical data, transitioning from a fee-for-service model to a value-based payment model [1][22] - The upcoming release of the DRG 3.0 version in 2026 is expected to further refine payment groupings and enhance the efficiency of medical insurance fund usage, hospital sustainability, and patient satisfaction [1][22] Payment Reform and Its Implications - The traditional fee-for-service model incentivized excessive medical practices, leading to issues like "over-prescription" and "over-testing" [1] - The DRG model shifts the focus from paying for services rendered to paying for patient outcomes, encouraging hospitals to control costs and reduce unnecessary procedures [1] - Some hospitals have imposed arbitrary limits on hospital stays, such as "no more than 15 days," which can negatively impact patient care [1][3] Collaboration Between Insurance and Healthcare Providers - Effective collaboration between medical insurance and healthcare institutions is crucial for the success of the DRG model, ensuring that funds are used efficiently while hospitals receive appropriate compensation [1][22] - In Anyang, a city implementing DRG, a "special cases, negotiated settlement" mechanism allows for separate billing for complex cases, ensuring that hospitals are not financially penalized for treating severe patients [8][10] Financial Outcomes and Efficiency - The Anyang region has seen a turnaround in its medical insurance fund, achieving a surplus after implementing the DRG model, with total fund expenditures reaching 2.66 billion yuan for special cases in 2024 [8][11] - The average hospitalization cost in Anyang decreased from over 11,100 yuan in 2020 to 9,780 yuan in 2024, a reduction of 11.99% [15] - The overall efficiency of the medical insurance fund has improved, maintaining a balance between income and expenditure, with a surplus of 5.78 billion yuan in 2024 [15] Day Surgery and Cost Reduction - The introduction of "day surgery" has allowed patients to complete procedures within 24 hours, significantly reducing hospitalization time and costs [19][21] - Nearly 60% of tertiary public hospitals in China have adopted day surgery, contributing to faster patient turnover and lower medical expenses [19] Future Directions for DRG Reform - The DRG 3.0 version is expected to introduce more detailed classifications for payment groups, addressing variations in disease severity and treatment methods [22] - Future efforts should focus on enhancing the service capabilities of primary care hospitals and facilitating patient referrals from community settings to hospitals for better resource allocation [22]