Xinhua News Agency, Beijing, April 18 (Reporter Xu Penghang) "At present, the results of the reform of medical insurance payment methods have begun to show, and medical, insurance and patients have initially won the lead." Xu Na, deputy director of the Medical Service Management Department of the National Medical Insurance Administration, said this at the 2025 Blue Book Reform of Medical Insurance Payment Methods held on the 18th.

At present, my country has achieved full coverage of DRG/DIP paid coordinated areas and full coverage of qualified medical institutions. Among the 393 coordinated regions across the country, 191 payments by disease group (DRG) and 200 payments by disease type score (DIP) are implemented. Tianjin and Shanghai have two payment models. The five mechanisms of special case single negotiation, advance payment, opinion collection, negotiation and consultation and data working group are constantly being improved.

According to reports, the medical insurance fund previously adopted the method of "paying by project". Although it is simple and convenient, it can easily induce problems such as rapid growth in medical expenses and repeated "over-medical care", and the labor value of medical personnel is not fully reflected. DRG/DIP payment can further standardize diagnosis and treatment behavior by grouping or converting scores of disease diagnosis and treatment and "packaging" payment.

"The win-win situation of the three parties includes balanced operation and improved use efficiency; medical institutions obtain more medical insurance surplus, and the internal income structure is improved; patients' economic burden of seeking medical treatment is reduced, and the cost of hospitalization is steadily reduced." Xu Na said.

In addition, the inclusion of hospitalization costs for medical treatment in other places in the management of payment by disease type is also steadily advancing. Long Xuewen, deputy director of the Medical Insurance Management Center of the National Medical Insurance Administration, introduced that as of the end of the first quarter of this year, 235 coordinated areas in 23 provinces have carried out inclusion of hospitalization costs for medical treatment in other places in the province in the province in the payment management according to the disease type, and 177 coordinated areas have actually paid.

It is reported that in July 2024, the National Health Insurance Administration released the DRG/DIP paid version 2.0 grouping plan, which is currently being implemented smoothly in various places. Xu Na said that in the next step, we will coordinate the construction of a diversified payment system, accelerate the improvement of supporting management mechanisms, focus on improving the level of digital and intelligent management, and steadily promote the implementation of the 2.0 version in groups.