Conflicts and Coordination between the Medical Service Price Classification Formation and the Medical Insurance Payment According to DRG/DIP
Zheng Daxi
Li Xing
Liu Jing
Abstract：Based on the price control of medical service items,medical insurance realizes the total cost control of medical services through the reform of payment methods.It analyzes the conflicts between the medical service price formation and payment based on DRG/DIP:measuring the medical insurance payment standard according to the historical average case cost rather than the diagnosis and treatment cost,and continuing the unreasonable price comparison relationship of items;new technologies,special medical service cases and DRG/DIP payment are not well connected,which hinders the demand for high quality and high price.It sorts out the linking practices of new medical service items and the implementation of market-regulated prices for non-basic medical service items and medical insurance payment,and obtains the enlightenment of other regions in promoting the formation of medical service price classification and the coordination of medical insurance DRG/DIP payment:fully applies cost information to the formation of reasonable medical service prices and the formulation of payment standards for patient groups(diseases);combines real-world data and health technology assessments to aid innovative medical technology pricing and payment access decisions;improves the inclusion standard,declaration procedure,review process and settlement method of DRG/DIP new technology special case;excludes the costs of eligible special medical care cases from the DRG/DIP payment criteria and fee settlement.
Keywords：medical service item priceclassification formationDRG/DIP paymentinnovative medical technologyexclusion paymentcost
Publication Date：2025-03-05
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 47-53 )