The National Healthcare Security Administration (NHSA) and the Ministry of Finance (MoF) have jointly released a notification requiring all provinces to include the direct settlement of hospitalization expenses in other places within the province in the Diagnosis Related Groups (DRG) and Diagnosis-Intervention Packet (DIP) payment systems by the end of 2025. This move aims to streamline healthcare payment processes and improve efficiency in managing hospitalization costs.
Unified Management and Coordination
The document specifies that expenses for medical treatment and hospitalization in different regions within the province will be uniformly managed under the DRG/DIP payment system at the place of medical treatment. This includes aligning with the payment methods used locally. The healthcare security administration department at the place of medical treatment will need to coordinate the management of core elements such as disease grouping, disease weight, rates, and coefficients. Supporting measures like special case negotiation, communication feedback, fund prepayment, and data analysis will also be implemented. Additionally, efforts will be made to include medical insurance funds settled in different places within the province into the total budget management of the place of medical treatment.
Gradual Unification of Payment Standards
In the early stages of the reform, based on the scale of settlement for medical treatment in other places, long-term residence, and distribution of referral personnel, the medical treatment location can set separate payment standards for inpatient diseases in other places within the province or adjust coefficients based on local standards. As the reform progresses, the payment gap between local and inter-provincial inpatient diseases is expected to narrow gradually.
Provincial Management and Coordination
Provincial healthcare security administration departments are required to implement overall management responsibilities and gradually unify DRG/DIP payment policies, technical standards, and service management. It is advised to coordinate payment levels for hospitalization diseases between local and provincial areas, balancing the reasonable needs of insured persons for medical treatment in different places with orderly medical treatment. Provinces with the necessary conditions are encouraged to explore the establishment of a joint office mechanism to jointly promote the implementation of DRG/DIP payment for intra-province medical treatment.
Information System Improvements
The document also calls for the improvement of information systems and the acceleration of the application of national DRG/DIP functional modules. It suggests expanding the quality control management scope of the medical insurance fund settlement list and supporting the settlement of hospitalization expenses in different provinces after being included in the medical treatment calculation. The medical destination should include hospitalization expenses from other places within the province in the local daily management scope, innovate payment methods for intelligent audit application scenarios, and achieve full process management.-Fineline Info & Tech
