国家医保局发布按病组和病种分值付费3.0版分组方案

国家医保局正式发布按病组和病种分值付费3.0版分组方案，对现行付费体系进行了重大优化。1相比2.0版，3.0版在结构上进行了较大幅度调整，其中按病组分组包括核心分组492个病组、细分组825个病组，按病种分值核心病种库则缩减至5125个病种，较2.0版的9520组减少接近一半。1同时，方案首次出台了基层病种，第一批基层病种包括DRG基层病组31个、DIP基层病种127个。1此外，严重合并症和并发症的数量比2.0版减少了近3000个，一般合并症和并发症的数量减少了1500多个。1

该改革已取得显著成效，2025年按病种付费的人次已占医保出院总人次的91.8%。1改革为医、保、患三方带来了实际利益，其中2025年全国职工医保、居民医保次均住院费用分别较2024年下降4.73%和0.94%，患者个人负担有所减轻。1国家医保局相关负责人黄心宇强调："支付方式改革不是医保的'控费'手段和目的"。1根据时间安排，原则上实施地区和医疗机构要在今年年底前完成3.0版分组的切换准备工作，2027年3月底前落地应用。1

The National Medical Insurance Bureau has released an updated grouping scheme for its version 3.0 disease-group and disease-based value payment system, marking a significant evolution from the previous 2.0 framework 1. The new standard introduces substantial modifications, including expanded disease groupings and a streamlined disease database, alongside the inaugural rollout of grassroots-level disease categories 1.

As of 2025, disease-based payment methods now account for 91.8% of all medical insurance discharge cases nationwide 1. The reforms have already demonstrated measurable financial impact, with average per-discharge hospital expenses for employee medical insurance declining 4.73% compared to 2024, while resident medical insurance expenses fell 0.94% year-over-year 1. The version 3.0 framework comprises core disease groupings (ADRG) consisting of 492 disease groups alongside 825 refined subdivisions 1. The core disease database has been substantially condensed to 5,125 disease types, representing a reduction of nearly half from the 9,520 categories in version 2.0 1. The first batch of grassroots disease categories includes 31 DRG-based grassroots groups and 127 DIP-based grassroots disease types 1.

Implementing regions and medical institutions are required to complete preparation work for the transition to version 3.0 by the end of this year, with full application expected by March 31, 2027 1. The revision reduced severe comorbidities and complications by approximately 3,000 categories while decreasing general comorbidities and complications by over 1,500 categories compared to version 2.0 1.