Quantitative Evaluation Analysis of China's Medical Insurance Payment Methods Reform Policies Based on PMC Index Model
Yu Ting
Chen Kaili
Liu Liyun
Abstract：Objective Analyze China's medical insurance payment reform since the new healthcare reform,current policy landscape and shortcomings,and provide references for refining the reform.Methods Using ROST CM 6 software to systematise national-level policy documents on payment system from 2009 to 2024,it identified the major payment methods and established a Policy Modeling Consistency(PMC)index system to quantitatively evaluate and compare major payment methods.Results Diagnosis-Related Groups(DRG)and Diagnosis-Intervention Packet(DIP)payment methods were the most frequently-referenced payment methods,indicating their central role in China's medical insurance reform agenda.PMC evaluation showed a higher policy quality for DIP(mean index=6.25)compared to DRG(mean index=5.76).Conclusion Since the new healthcare reform,policy iterations had driven the establishment of a diversified composite payment system.Medical insurance payment method reforms had entered a phase of precision development.As the two primary payment methods,the number and frequency of DIP payment policies were lower than those of DRG payment policies,but their policy quality surpassed that of DRG payment policies.Both DRG and DIP shared challenges including short-term policy orientation,limited stakeholder perspectives,and insufficient incentives.The findings suggested to strengthen the combined use of DRG/DIP with other payment methods in the policy implementation of medical insurance payment approaches reform.
Keywords：medical insurance payment method reformpolicy textPolicy Modeling Consistency index modelDRGDiagnosis-Intervention Packet
Publication Date：2026-03-05
Online Publishing Date：2026-03-18(First online date of this platform, not the publication date of the document)
Pages：6( 44-49 )