Medical insurance settlement re-optimization version 3.0 plan avoids "one-size-fits-all" for complex cases

Reporters learned yesterday (the 19th) from the National Healthcare Security Administration that in July this year, the grouping plan for Version 3.0 of diagnosis-related group (DRG) payment will be released, and it will be officially implemented in January next year. The settlement method of the medical insurance fund with hospitals will be further optimized. The traditional medical insurance payment method is fee-for-service, covering drugs, consumables, and service items, settled according to usage. Since 2019, the National Healthcare Security Administration has been promoting the reform of “paying by diagnosis-related groups,” which means that the medical insurance department groups inpatient cases with similar conditions and comparable treatment methods, calculates a unified cost standard based on historical data, and “bundles” the payment to hospitals. The shift to DRG payment does not change patients’ medical insurance benefits but alters the settlement method between the medical insurance fund and hospitals, transforming the previous “pay for the process” into “pay for the outcome.” The National Healthcare Security Administration released two versions of the DRG payment plan successively in 2019 and 2024. (CCTV News)