By hannover-web.com On the morning of September 10, the State Council Information Office held a press conference featuring Li Tao, the Deputy Director of the National Healthcare Security Administration. Li discussed the ongoing reforms in healthcare payment methods.
Li underscored the administration’s commitment to implementing the central government’s decisions and directives, stressing the importance of advancing reforms in medical insurance payment mechanisms.
In recent years, there have been notable advancements in inpatient care, particularly with the faster rollout of the Diagnosis-Related Group (DRG) and Diagnosis-Intervention Package (DIP) payment models. In simple terms, this represents a shift to a bundled payment system that focuses on specific diseases and groups. The aspiration is to achieve comprehensive coverage across all coordinated regions in the country by the end of 2023. This initiative has driven four major transformations: first, the payment structure has moved from a fee-for-service model to one based on disease-specific bundled payments. Second, the settlement of healthcare funds has transitioned from a fee-for-service model to a prepayment system. Third, there is now a shift from manual audits to the application of big data. Finally, the management of medical services has evolved from a general oversight approach to a more detailed and nuanced management style. These changes have established a management mechanism that centers on overall budgets, assessment and supervision, retention of surplus, and shared overspending. This not only enhances standardized treatment, rational medication usage, and operational efficiency but also promotes cost control, ultimately lightening the financial burden on patients while saving them time and fostering interconnected development across healthcare, insurance, and pharmaceuticals.
Li acknowledged that reforming payment methods is an ongoing optimization process. Recently, responding to feedback from medical institutions about challenges such as inadequate granularity in grouping plans and restrictions on inpatient days, the administration launched the 2.0 version of the disease-based bundled payment scheme. This update aims to refine technical standards and supporting policies for medical insurance payments, while establishing new working mechanisms that prioritize special case negotiations, prepayment systems, data feedback collection, and collaborative discussions. For example, hospitals now have the opportunity to submit requests for reviews in cases where patients experience extended hospital stays, incur high medical costs, or require new treatments and technologies for complex conditions. This collaborative approach allows for adjustments to payment standards in order to better meet clinical needs and address patients’ concerns regarding substantial medical expenses.
Looking, Li affirmed that the National Healthcare Security Administration will maintain its focus on addressing public concerns while continuing to deepen payment method reforms. This includes a commitment to establishing a dynamic adjustment mechanism for DRG/DIP payments to better meet clinical needs and enhance the efficiency of healthcare fund payments. Additionally, efforts will be made to develop a diversified payment system catering to outpatient services and integrated medical communities. Strengthening collaboration with health agencies will also be a key priority to ensure comprehensive governance in medical services and protect the public’s health rights.
