In order to implement the pay by disease group (DRG) and disease score (DIP) 2.0 grouping scheme, the National Healthcare Security Administration recently issued the "Notice on Issuing the Pay by Disease Group and Disease Score 2.0 Grouping Scheme and Deepening Relevant Work" (hereinafter referred to as the "Notice"). The National Healthcare Security Administration actively promotes the reform of diversified and compound medical insurance payment methods, mainly based on payment by disease. China has successively launched pilot projects for DRG and DIP payment methods. The so-called DRG payment refers to payment based on disease diagnosis related grouping. That is to say, according to factors such as disease diagnosis, severity of illness, and treatment methods, patients are divided into diagnosis related groups with similar clinical symptoms and resource consumption. On this basis, medical insurance will be paid according to the corresponding payment standards. The so-called DIP payment refers to payment based on disease score. Under the total budget mechanism, the point value is calculated based on the annual medical insurance payment total, medical insurance payment ratio, and the total score of each medical institution case, forming payment standards and achieving standardized payment for each medical institution case. By the end of 2023, over 90% of the overall planning areas in China have carried out DRG/DIP payment reform, which has played a positive role in promoting medical institutions to actively control costs and standardize diagnosis and treatment behavior. However, with the deepening of payment method reform, some local medical insurance departments, medical institutions, and medical personnel have raised concerns about the current grouping being not precise enough and not closely related to clinical practice. They hope that the government can dynamically adjust the grouping. To effectively respond to concerns from all parties, the National Healthcare Security Administration collects real historical data of medical institutions through the healthcare information platform. DRG collects 53.71 million case data from 78 cities since 2020, while DIP collects 47.87 million case data from 91 cities, forming a basic database. After statistical analysis by statistical experts, dozens of clinical trials were conducted with the support of the Chinese Medical Association, the Chinese Stomatological Association, and others. The opinions and suggestions of health departments, finance departments, local medical insurance departments, and medical institutions were widely solicited and absorbed, forming the 2.0 version grouping scheme. The Notice requires that, in principle, the newly launched DRG/DIP payment areas in 2024 should directly use version 2.0 grouping, and those that have already started should complete the preparation work for the switch before December 31, 2024, to ensure that all planning areas will uniformly use the grouping version from 2025 and improve the standardization and uniformity of payment methods. The Notice reminds that existing policy arrangements should be fully utilized to empower medical institutions, and the special case negotiation mechanism should be well utilized. For cases that are not suitable for payment according to DRG/DIP standards due to long hospitalization time, high medical expenses, consumption of new drugs and technologies, complex critical illnesses, or multidisciplinary joint diagnosis and treatment, medical institutions can independently apply for special case negotiation. The medical insurance agency will organize expert review and evaluation on a quarterly or monthly basis, and the number of applications should generally be within 5% of the total DRG discharged cases or 5 ‰ of the total DIP discharged cases. The Notice requires that the fund liquidation of the previous year be fully completed by the end of June of the following year. At the same time, it is explicitly stated that medical institutions shall not use DRG/DIP payment standards as a limit to assess medical personnel or link them to performance allocation indicators. Encourage the use of fund prepayments to alleviate the financial pressure on medical institutions. Each region can prepay about one month's advance payment to designated medical institutions based on the fund balance. The Notice requires a comprehensive clean-up of the medical insurance fund payable and unpaid before 2023 according to the agreement before the end of September this year. (New Society)