国家医保局发布按病种付费3.0版分组方案，首次明确基层病种并推行"同病同付"制度1。根据该方案，患者因同一种病就医时，不论就诊地点是大医院还是基层医疗机构，在统筹地区内将执行相同的医保支付标准1。新方案在分组精细度上有显著提升，DRG细分组从634组增加到825组，增加191组1；ADRG核心分组增加到492组，较2.0版方案增加83组1。其中，DRG基层病组设置31个，DIP基层病种127个1。
为进一步优化支付结构，新方案对基层就医患者降低起付线、提高报销比例，以激励基层医疗机构提升服务能力1。方案增加了对老幼特殊群体和创新技术的支持，针对6岁以下和70岁及以上病例进行了细分，并为无痛分娩设立了三个独立支付分组1。截至2025年，按病种付费人次已占医保出院总人次的91.8%1。同时，22个省份的住院总费用呈现出药耗占比下降、医疗服务费用占比上升的结构性变化1。国家医保局医药服务管理司司长黄心宇强调，"支付方式改革不是'控费'手段"1。
The National Medical Insurance Bureau has released the 3.0 version of its diagnosis-related group (DRG) payment scheme, establishing standardized reimbursement rates for primary care facilities for the first time 1. Under the new "same disease, same payment" framework, patients receive identical medical insurance coverage regardless of whether they seek treatment at large hospitals or grassroots medical institutions within the same administrative region 1.
The updated classification system introduces more granular groupings, expanding DRG categories from 634 to 825 groups, an increase of 191 groups, while core ADRG groupings have grown to 492 categories, representing 83 additional groups compared to the previous 2.0 version 1. The scheme designates 31 DRG-based primary care disease groups and 127 DIP-based primary care disease types 1. Meanwhile, the national DIP disease library's core disease classifications have been consolidated from 9,520 groups to 5,125 groups 1. By 2025, diagnosis-related group payments have accounted for 91.8% of all insured hospital discharges 1.
The new approach incorporates special provisions for vulnerable populations and emerging medical technologies, including three independent payment classifications for painless childbirth and refined categorizations for children under six and elderly patients over seventy 1. To incentivize service quality improvements at primary care levels, the scheme reduces deductibles and increases reimbursement ratios for grassroots facility patients 1. According to Huang Xinyu, director of the Medical and Pharmaceutical Service Management Division of the National Medical Insurance Bureau, "payment method reform is not a cost-control measure" 1. Data from twenty-two provinces demonstrate a structural shift in hospital expenses, with declining pharmaceutical and supply proportions offset by rising medical service fees 1.
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