The Shanxi Provincial Healthcare Security Bureau has mandated that all regional authorities within the province align with the National Healthcare Security Administration's interim measures for disease-based payment management.

This initiative aims to systematically advance the reform of healthcare payment methods, enhancing the utilization efficiency of medical insurance funds and safeguarding the legal rights of insured individuals.

Traditionally, China's healthcare payment system has operated on a fee-for-service basis, where expenses for drugs, consumables, and services are billed according to usage. This model often leads to over-prescription and excessive testing. To regulate medical practices, since 2019, the National Healthcare Security Administration has been promoting a shift to a disease-based payment system.

Disease-based payments in China currently include Diagnosis-Related Groups (DRG) and Diagnosis-Intervention Packet (DIP) payment models. According to the interim measures, a dynamic adjustment mechanism for disease grouping will be established, with revisions occurring approximately every two years.

For complex cases involving severe conditions or the application of new drugs and technologies, the measures introduce a "special case negotiation" mechanism. This allows for the submission of cases that require extended hospital stays, high resource consumption, or multidisciplinary consultations. Reviews will be conducted monthly or quarterly, allowing the submitted cases to be billed on a fee-for-service basis or with adjusted payment standards.