The 2025 Medical Insurance Payment Method Reform Blue Book Press Conference and Trend Exchange Conference was held in Beijing on April 18. Xu Na, deputy director of the Medical Management Department of the National Medical Insurance Administration, said in his speech that the reform of payment methods has achieved positive results. Paying by disease type basically achieves full coverage, forming a national "chess game".

  Xu Na introduced that as of now, 191 payments by disease group (DRG) and 200 payments by disease type score (DIP) are implemented among the 393 coordinated regions across the country. Tianjin and Shanghai have both payment models, achieving full coverage of coordinated regions and full coverage of qualified medical institutions, with disease type coverage reaching 95%, and medical insurance fund coverage reaching 80%.

  She also introduced that the payment mechanism is constantly improving and the policy tools are richer, among which the five mechanisms of special case negotiations, advance payments, opinion collection, negotiation and consultation and data working group are constantly improving. The results of the payment method reform have begun to show, and medical care, insurance and patients have initially won the win-win situation. For example, the fund operation is balanced, and the efficiency of use is improved; medical institutions obtain more medical insurance surpluses, and the internal income structure is improved; the economic burden of patients seeking medical treatment is reduced, and the cost of hospitalization is steadily reduced.

  Xu Na also pointed out that there are still three major challenges: there are contradictions between the increase in medical expenses and the management of payment methods, the overall quality of reform still has a lot of room for improvement, and the lack of overall coordination and joint efforts of multiple parties in the reform. In the future, we will take measures such as coordinating the construction of a diversified payment system, accelerating the improvement of supporting management mechanisms, strengthening coordination of payment reform work, and focusing on improving the level of digital and intelligent management. We will keep a close eye on the key tasks of the final three-year action plan, steadily promote the implementation of the 2.0 version in groups, focus on improving quality and efficiency, and continue to promote the reform of medical insurance payments in depth and in practice.

  Long Xuewen, deputy director of the Medical Insurance Center of the National Medical Insurance Administration, said in his speech that as an executor of the reform, the medical insurance management system has always adhered to "serving people's livelihood, ensuring fairness, and improving efficiency" and achieved positive results.

  Long Xuewen introduced that the standardization and standardization of payment methods are constantly improving. In January this year, the National Health Insurance Administration issued the "Regulations on Paying Medical Insurance by Disease Type (2025 Edition)". The new version of the regulations is the inheritance and development of the 2021 trial version of the regulations, and has been optimized and improved in combination with the practice of payment method reform in the past three years to meet the requirements of the 2.0 grouping plan and working mechanism of the payment group and disease type score.

  Long Xuewen said that the inclusion of hospitalization costs in other places in the management of paid by disease type is steadily advancing. As of the end of the first quarter, in addition to 6 provincial-level coordinated provinces and 11 coordinated areas that are not used as medical treatment places, 235 coordinated areas in 23 provinces have carried out inclusion of hospitalization costs for medical treatment in other places within the province in the province in the payment management according to the disease type, and 177 coordinated areas have actually paid.

  He also mentioned that the reform of medical insurance settlement has made steady progress and made in-depth breakthroughs. In 2024, the medical insurance fund prepayment system will be unified and improved at the national level, and areas with safe fund operation will be supported to prepay funds to designated medical institutions with good credit at the beginning of the year. The total prepayment scale in the first quarter of 2025 was 72.3 billion yuan, effectively solving the problem of hospital advancement, helping public hospitals to go lightly, and investing more resources in discipline construction and service optimization. As of the end of March, 24 provinces across the country implemented instant settlement of medical insurance funds, covering 246,700 designated medical institutions, and allocated 165.7 billion yuan, effectively alleviating the pressure on hospital operations and injecting "real water from the source" into the improvement of medical service quality.

  During the event on the 18th, the first blue book on medical insurance payment method reform - "China Medical Insurance Payment Method Reform and Development Report (2023-2024)" published by China Medical Insurance Magazine and Social Sciences Documentation Press. The Blue Book comprehensively reviews the progress and achievements of my country's medical insurance payment method reform based on the current medical reform focus, policy-oriented, people's livelihood care and social benefits, selects advanced reform experiences of medical insurance payment methods in some countries and regions, and looks forward to the situation and focus of the reform of medical insurance payment methods in the next stage, and puts forward relevant countermeasures and suggestions. The book integrates theory and practice, provides effective reference for the theoretical research and practical work of medical insurance departments, medical institutions, universities, and scientific research departments, and is highly authoritative and guiding.

  Hundreds of representatives from the National Medical Insurance Administration, China Medical Insurance Research Association, the National Medical Insurance Research Institute of Capital Medical University, as well as universities, medical institutions, and local medical insurance departments attended the event on the day to jointly analyze and judge the current situation and development trends of the reform of medical insurance payment methods, and discuss countermeasures and suggestions for improving quality and efficiency of medical insurance payment methods. (Reporter Li Chun)

[Editor in charge: Zhang Qiaosu]