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China Healthcare Policy Pulse
中国健康政策脉动
CN
DRG/DIP2.0版分组方案正式发布
在前几期文章中提到的DRG/DIP分组方案2.0方案，终于在近日落地。国家医疗保障局于7月23日正式发布了《关于印发按病组（DRG）和病种分值（DIP）付费2.0版分组方案并深入推进相关工作的通知》（以下简称《通知》），明确自2025年起，全国各统筹地区将统一采用这一新版分组方案。
自2019年DRG/DIP支付方式改革试点启动以来，历经六年的推广，全国九成以上统筹区域已成功实施DRG/DIP付费机制。鉴于前期1.0版本在临床实践中暴露出部分组别与实际操作脱节的问题，2.0版本应运而生。通过优化分组方法及统计规则，使治疗技术难度等关键指标更加贴近临床实际，整体呈现出DRG分组精细化、DIP分组集中化的特点。
尤为值得关注的是，《通知》对“特例单议”规则进行了优化调整，审议频率由年度调整为季度或月度，同时设定了特例单议数量的比例，即不超过DRG出院病例总数的5%或DIP出院病例总数的千分之五。此外，还单独明确了 “除外机制”，即在新技术的初期应用提供灵活付费方式，如按项目付费或点数加成，待数据积累充分后再纳入DRG/DIP体系，为创新医疗产品的临床应用铺设了更加顺畅的道路。
此外，医保局也表示将完善DRG/DIP支付方式的分组动态调整机制。基于2023年的广泛调研，大多数DRG和DIP改革地区分别建议每两年、每年更新一次分组，以确保规则与医疗实践同步发展，满足临床需求。
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DRG/DIP Payment Guideline 2.0 Unveiled
On July 23, the National Healthcare Security Administration (NHSA) published the Notice on Issuing the 2.0 Grouping Guideline of Payment by Diagnosis Related Groups (DRG) and Diagnosis Intervention Packet (DIP) and Relevant Work (“Notice”). Starting from 2025, all coordinated regions across the country will uniformly adopt this new guideline.
The DRG/DIP payment reform pilot, initiated in 2019, has been adopted by over 90 percent of the nation's coordinated regions. The initial version revealed that the categorisation of patient groups did not accurately reflect real-world clinical practices, prompting Version 2.0 to refine the grouping methodology and payment rules. Key indicators, such as the technical difficulty of treatment, now have revised criteria to better align with clinical realities. Overall, the new DRG grouping mechanism has been refined, and the DIP grouping mechanism has been centralised.
A notable update in the Notice is the optimisation and adjustment of rules for special cases. The frequency of reviewing and making decisions about these special cases has been increased from annually to quarterly or monthly. Additionally, the ratio of special cases has been capped at five percent of total DRG inpatient discharges and 0.5 percent of total DIP discharges. The Notice also introduces an ‘exclusion mechanism’ that allows for flexible payment methods, such as per-project or point-plus payment, for the initial application of new technologies. Once sufficient data is gathered, these technologies will be integrated into the DRP/DIP system, supporting a smoother introduction of innovative medical products into clinical practice.
NHSA also plans to improve the dynamic adjustment mechanism of the DRG/DIP payment method. Following extensive research conducted in 2023, most pilot regions for DRG and DIP reform have proposed updating DRP groupings every two years and DIP groupings annually. This will ensure that the rules keep pace with the latest advancements in medical care, ensuring they remain relevant and effective in addressing current healthcare needs.
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