1. In order to accelerate the reform of grouping full coverage according to disease diagnosis (DRG)/ disease score (DIP), the National Medical Insurance Bureau has formulated the Three-year Action Plan for the Reform of DRG/DIP Payment Method, which makes it clear that by the end of 2025, DRG/DIP payment method will cover all eligible medical institutions providing hospitalization services, and basically achieve full coverage of diseases and medical insurance funds. With the goal of accelerating the establishment of an effective and efficient medical insurance payment mechanism, it is planned to accelerate in stages. In 2022-2024, the reform task of DRG/DIP payment method will be fully completed to promote the high-quality development of medical insurance; Before the end of 2024, all the national coordinated areas will carry out the reform of DRG/ allocation payment methods, start the pilot areas ahead of schedule, and continuously consolidate the reform results; By the end of 2025, DRG/DIP payment will cover all eligible medical institutions that provide hospitalization services, and basically achieve full coverage of diseases and medical insurance funds.
2.DRG is to pay according to the relevant groups of disease diagnosis, and divide inpatients into a certain number of disease groups according to the severity of the disease, the complexity of treatment methods and the similarity of resource consumption. On this basis, the medical insurance fund is no longer paid to medical institutions according to the actual cost of patients in the hospital (that is, according to the service items), but is packaged and paid according to the payment standard of the diagnosis-related group where the cases enter. DIP means paying according to the disease score. Based on historical data, according to the proportional relationship between the average cost and technical difficulty of each disease and a certain benchmark disease, the corresponding disease score is determined, and then the total payment amount is calculated by combining the unit price of the score and the total score of each medical institution. Generally speaking, both of them require hospitals to use more effective methods for diagnosis and treatment through prepaid mode. If the hospital's expenses exceed, it will be borne by the hospital itself, and the savings will also be owned by the hospital, which will force the hospital to manage finely and use the medical insurance fund reasonably.