按病种付费分组方案3.0版预计7月公布，调整重点有哪些？-行业新闻-医院绩效咨询,医院绩效管理,医院管理咨询 -九鼎医院管理顾问

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行业新闻

按病种付费分组方案3.0版预计7月公布，调整重点有哪些？

提交者：发表时间：2026-4-1点击次数：1069来源:国家医保局

我国医保支付方式改革将迎来再升级，DRG/DIP 3.0版分组方案预计7月公布，最快2027年1月全国落地执行。

3月19日，国家医保局召开按病种付费分组方案3.0版调整情况介绍活动。据了解，2025年7月，国家医保局启动了DRG/DIP分组方案3.0版调整工作，目前已形成3.0版第一阶段的临床论证结果。

第一个方面：总体工作安排

2024年7月，国家医保局印发了按病种付费分组方案2.0版，对2020年发布的1.0版进行了调整优化。医疗机构普遍反映2.0版分组方案较1.0版更为精准，更具操作性。为推动按病种付费工作的规范化、制度化，2025年8月，国家医保局制定了《医疗保障按病种付费管理暂行办法》，明确病种分组方案原则上每两年调整一次。按照这个时间节奏，从去年下半年开始，国家医保局就着手准备新版分组方案的调整制定工作，起草了相应的《工作方案》，并与财政部、国家卫生健康委、国家中医药管理局等部门达成一致。

（一）关于调整原则和依据。分组方案调整主要有4方面依据，坚持4条基本原则。4方面依据分别是近年来医保结算的真实数据、广泛收集的各方意见建议、医疗技术发展变化情况，以及医保政策和管理要求。4条基本原则，一是坚持积极稳妥，在定期动态调整的同时保持版本间的延续性；二是坚持公开透明，向社会公开征集意见建议，依托行业学会开展临床论证；三是坚持改革联动，分组方案调整与医保相关改革、政策调整协同推进；四是坚持分级管理，国家发布分组方案，地方可按规则细化调整，做好应用。

（二）关于调整主要内容。聚焦临床意见较为集中的年龄、合并症并发症等影响因素，有针对性地完善年龄细分组、单双侧/多部位手术、产科分组、恶性肿瘤放化疗、联合手术等分组规则，DRG主要调整核心分组和细分组，DIP主要调整核心病种库，同时，还着眼DRG/DIP未来的融合发展，在相关技术基础方面做好统筹协调。

（三）关于进度安排。整个调整工作大致可以分为三个阶段：一是准备阶段。主要是制定工作方案，收集基础数据，征集社会各方的意见建议。二是形成分组阶段。通过临床论证、数据统计分析验证、测试应用，征求意见等流程，形成3.0版分组方案，同步更新技术规范。三是结果发布阶段。预计于今年7月份左右公开发布3.0版分组方案，做好政策解读和宣传培训，计划2027年1月正式执行。

第二个方面：工作进展情况

目前，分组方案调整工作按照既定安排顺利推进。一是完成意见收集和整理。去年7月中旬到11月底，国家医保局集中时间向社会各方征集意见，组织了多场相关部门、行业学会、医疗机构代表等参加的座谈交流，通过医保服务平台APP、局官网和微信公众号、微信和支付宝小程序、书面定向收集等方式，共收集意见建议约3.5万条，其中有效意见约3万条，大部分意见针对的是病种分组规则调整、疾病诊断和手术操作编码更新等技术问题。二是完成历史数据采集。通过国家医保信息平台采集全国2022年至2025年上半年医保结算清单数据，形成包含约10亿份病例结算数据的样本库，做好充分的数据储备。三是完成第一阶段临床论证。今年1月下旬，DRG专家分为30个临床专业开展论证，重点对DRG核心分组（ADRG）的结构、内涵和入组规则进行了讨论，大部分专业组对ADRG调整意见达成一致或基本达成一致，有的专业组在论证中又提出了新意见，这些将在第二阶段临床论证中进一步讨论。3月初，DIP专家分为25个专业开展论证，各专业组对增加先期分组、手术操作并项等结果表示基本同意，对少数病种提出了进一步合并或细化意见。

医院绩效咨询

第三个方面：本次3.0版分组调整的3个主要特点

（一）部门合作更加紧密协同。各级医保部门是支付方式改革的实施主体、责任主体，而改革落地的“最后一公里”在医疗机构、临床一线。为使3.0版分组方案更贴合医疗实际，国家医保局与国家卫生健康委、国家疾控局等部门建立了顺畅的协同合作机制。国家卫生健康委医政司推荐了来自医院管理研究所、卫生发展研究中心、妇幼中心等委内科研单位的20余名专家全程参与DRG/DIP技术指导组工作。同时，医政司、医院管理研究所还协调中华医学会、中华口腔医学会各相关专业分会的知名专家参加临床论证，国家疾控局传防司也推荐了相关感染专业专家参与论证。

（二）专家论证更加科学权威。按病种付费分组技术具有学科交叉的特点。今年的分组调整工作，参与专家的数量、层次都可以说是“历次之最”。DRG方面，中华医学会、中华口腔医学会共推荐168名专家参与临床论证，其中专业分会主任委员（含前任主任委员、候任主任委员）34人，副主任委员33人，各临床专业组的组长由分会主委、候任主委担任，有的专业（如泌尿外科），参与论证的专家均为副主委以上。DIP方面，今年首次大规模开展分组调整的临床论证工作，来自中华医学会、中华口腔医学会以及部分地方医院的97名专家参与。此外，还有近百位来自全国各地医院的医保、编码和统计等领域专家也共同参与论证。

（三）组织工作更加细致周密。随着支付方式改革的深入推进，医保部门、医疗机构对病种付费的认识和理解也不断加深。尽管具体的支付方式不直接影响医保基金的整体支出，但支付方式对于不同医院、不同专业、不同科室的发展，对医疗行为的引导具有非常重要的作用，因此卫生行业对支付方式的关注度持续提高，对改革的精细化、规范化要求也越来越高。为此，我们特别注重分组方案调整的程序性、规范性，特别重视意见收集、数据采集和临床论证，可以说分组调整的每个工作环节都是经过充分研究、广泛征求意见确定的，收集到的每条意见都经过了专家们的认真讨论，采集到的每条数据都记录了医疗机构真实的医疗服务，论证的每个病种都体现了严谨科学的专业精神。

第一阶段临床论证重点

DRG技术指导组组长颜冰在介绍DRG第一阶段临床论证情况时表示，3.0版分组方案的升级不是对2.0版的简单修补，而是一次顺应临床发展、技术进步以及群众期盼的系统性优化。

截至2025年11月底，通过各种渠道收集意见2万余条。DRG技术指导组对意见进行汇总，逐条对意见进行筛选、分析，最终形成有效意见约1.7万条，涉及124个核心分组，几乎涵盖所有临床专业，主要集中在肿瘤、重症、单双侧手术、妇产、儿科、老年病、康复、疼痛、新技术等方面。

颜冰表示，从第一轮的临床论证整体结果看，大部分意见达成了共识，说明了前期意见梳理和数据准备工作扎实有效，也印证了3.0版分组方案的调整方向与临床实际需求高度契合。

比如，在肿瘤方面，前期在意见征集阶段提出了化疗要联合其他治疗的意见，经过肿瘤临床专家们的论证，同意增加。在康复方面，专家也同意在神经、呼吸、循环、肌肉骨骼系统四个疾病大类中，各增加一个康复专业的ADRG组（核心分组），这充分体现了康复在现代医疗体系中的作用。DIP付费3.0版分组方案调整共收到社会各方反映意见建议1.2万条，主要集中在优化部分病种的分组逻辑，更新疾病诊断和手术操作编码等方面。

经过专家讨论，结合地方实践经验，DIP3.0版分组规则预计作如下优化：保持原有基本规则不变，一是体现DIP和DRG融合发展，二是优化分组流程，三是优化分组规则，包括对诊断和操作的“合并、细分、辅助”，提升临床适配度。

在这次活动中，国家医保局邀请感染疾病科、胸外科、眼科、新生儿科、骨科5个学科临床论证专家分别介绍了本领域临床论证及意见沟通情况。

骨科论证专家，北京积水潭医院副院长吴新宝认为，DRG骨科临床论证通过聚焦技术难度、资源消耗与临床实际，优化了骨科ADRG组结构，理顺了入组逻辑，有效提升了分组的科学性、规范性与适用性。

在骨科临床论证中，膝关节置换是讨论的热点之一，尤其是关于“双侧关节同时置换”是否应该单独分组的问题。

过去，很多老年人虽然两个膝盖都有问题，但因为手术创伤大、费用高，只能分期做，先换一边，恢复很久再换另一边。但现在情况变了：一方面，大家的身体条件普遍更好，能承受一次完成双侧手术；另一方面，国家集采大幅降低了关节假体的费用，因此希望一次住院、同时把两个膝盖都换好的患者越来越多。

专家们论证后认为，将双侧多部位关节置换从原有的关节置换组中分离出来，建议将双侧、多部位关节置换术从原有的关节置换术组中单独分出来。既符合临床实际需求，也能更好地支持这种对患者康复更高效的治疗方式。

“调整后的DRG/DIP 3.0版骨科分组方案落地后，将更科学地体现骨科的诊疗价值，有效激励医疗机构提升服务质量和技术水平，最终让广大的骨科患者和家庭受益。”吴新宝说。

黄心宇表示，下一步国家医保局将根据工作安排，尽快组织开展第二阶段的临床论证，结合数据验证形成3.0版分组方案，按程序予以发布，不断完善我国医保支付政策体系。

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PHP Authors
Contribution	Authors
Zend Scripting Language Engine	Andi Gutmans, Zeev Suraski, Stanislav Malyshev, Marcus Boerger, Dmitry Stogov, Xinchen Hui, Nikita Popov
Extension Module API	Andi Gutmans, Zeev Suraski, Andrei Zmievski
UNIX Build and Modularization	Stig Bakken, Sascha Schumann, Jani Taskinen
Windows Port	Shane Caraveo, Zeev Suraski, Wez Furlong, Pierre-Alain Joye, Anatol Belski
Server API (SAPI) Abstraction Layer	Andi Gutmans, Shane Caraveo, Zeev Suraski
Streams Abstraction Layer	Wez Furlong, Sara Golemon
PHP Data Objects Layer	Wez Furlong, Marcus Boerger, Sterling Hughes, George Schlossnagle, Ilia Alshanetsky
Output Handler	Zeev Suraski, Thies C. Arntzen, Marcus Boerger, Michael Wallner

SAPI Modules
Contribution	Authors
AOLserver	Sascha Schumann
Apache 1.3 (apache_hooks)	Rasmus Lerdorf, Zeev Suraski, Stig Bakken, David Sklar, George Schlossnagle, Lukas Schroeder
Apache 1.3	Rasmus Lerdorf, Zeev Suraski, Stig Bakken, David Sklar
Apache 2.0 Filter	Sascha Schumann, Aaron Bannert
Apache 2.0 Handler	Ian Holsman, Justin Erenkrantz (based on Apache 2.0 Filter code)
Caudium / Roxen	David Hedbor
CGI / FastCGI	Rasmus Lerdorf, Stig Bakken, Shane Caraveo, Dmitry Stogov
CLI	Edin Kadribasic, Marcus Boerger, Johannes Schlueter, Moriyoshi Koizumi, Xinchen Hui
Continuity	Alex Leigh (based on nsapi code)
Embed	Edin Kadribasic
FastCGI Process Manager	Andrei Nigmatulin, dreamcat4, Antony Dovgal, Jerome Loyet
ISAPI	Andi Gutmans, Zeev Suraski
litespeed	George Wang
NSAPI	Jayakumar Muthukumarasamy, Uwe Schindler
phpdbg	Felipe Pena, Joe Watkins, Bob Weinand
phttpd	Thies C. Arntzen
pi3web	Holger Zimmermann
Sendmail Milter	Harald Radi
thttpd	Sascha Schumann
tux	Sascha Schumann
WebJames	Alex Waugh

Module Authors
Module	Authors
BC Math	Andi Gutmans
Bzip2	Sterling Hughes
Calendar	Shane Caraveo, Colin Viebrock, Hartmut Holzgraefe, Wez Furlong
COM and .Net	Wez Furlong
ctype	Hartmut Holzgraefe
cURL	Sterling Hughes
Date/Time Support	Derick Rethans
DB-LIB (MS SQL, Sybase)	Wez Furlong, Frank M. Kromann
DBA	Sascha Schumann, Marcus Boerger
DOM	Christian Stocker, Rob Richards, Marcus Boerger
enchant	Pierre-Alain Joye, Ilia Alshanetsky
ereg	Rasmus Lerdorf, Jim Winstead, Jaakko Hyvätti
EXIF	Rasmus Lerdorf, Marcus Boerger
fileinfo	Ilia Alshanetsky, Pierre Alain Joye, Scott MacVicar, Derick Rethans
Firebird driver for PDO	Ard Biesheuvel
FTP	Stefan Esser, Andrew Skalski
GD imaging	Rasmus Lerdorf, Stig Bakken, Jim Winstead, Jouni Ahto, Ilia Alshanetsky, Pierre-Alain Joye, Marcus Boerger
GetText	Alex Plotnick
GNU GMP support	Stanislav Malyshev
Iconv	Rui Hirokawa, Stig Bakken, Moriyoshi Koizumi
IMAP	Rex Logan, Mark Musone, Brian Wang, Kaj-Michael Lang, Antoni Pamies Olive, Rasmus Lerdorf, Andrew Skalski, Chuck Hagenbuch, Daniel R Kalowsky
Input Filter	Rasmus Lerdorf, Derick Rethans, Pierre-Alain Joye, Ilia Alshanetsky
InterBase	Jouni Ahto, Andrew Avdeev, Ard Biesheuvel
Internationalization	Ed Batutis, Vladimir Iordanov, Dmitry Lakhtyuk, Stanislav Malyshev, Vadim Savchuk, Kirti Velankar
JSON	Omar Kilani, Scott MacVicar
LDAP	Amitay Isaacs, Eric Warnke, Rasmus Lerdorf, Gerrit Thomson, Stig Venaas
LIBXML	Christian Stocker, Rob Richards, Marcus Boerger, Wez Furlong, Shane Caraveo
mcrypt	Sascha Schumann, Derick Rethans
MS SQL	Frank M. Kromann
Multibyte String Functions	Tsukada Takuya, Rui Hirokawa
MySQL driver for PDO	George Schlossnagle, Wez Furlong, Ilia Alshanetsky, Johannes Schlueter
MySQL	Zeev Suraski, Zak Greant, Georg Richter, Andrey Hristov
MySQLi	Zak Greant, Georg Richter, Andrey Hristov, Ulf Wendel
MySQLnd	Andrey Hristov, Ulf Wendel, Georg Richter, Johannes Schlüter
OCI8	Stig Bakken, Thies C. Arntzen, Andy Sautins, David Benson, Maxim Maletsky, Harald Radi, Antony Dovgal, Andi Gutmans, Wez Furlong, Christopher Jones, Oracle Corporation
ODBC driver for PDO	Wez Furlong
ODBC	Stig Bakken, Andreas Karajannis, Frank M. Kromann, Daniel R. Kalowsky
OpenSSL	Stig Venaas, Wez Furlong, Sascha Kettler, Scott MacVicar
Oracle (OCI) driver for PDO	Wez Furlong
pcntl	Jason Greene, Arnaud Le Blanc
Perl Compatible Regexps	Andrei Zmievski
PHP Archive	Gregory Beaver, Marcus Boerger
PHP Data Objects	Wez Furlong, Marcus Boerger, Sterling Hughes, George Schlossnagle, Ilia Alshanetsky
PHP hash	Sara Golemon, Rasmus Lerdorf, Stefan Esser, Michael Wallner, Scott MacVicar
Posix	Kristian Koehntopp
PostgreSQL driver for PDO	Edin Kadribasic, Ilia Alshanetsky
PostgreSQL	Jouni Ahto, Zeev Suraski, Yasuo Ohgaki, Chris Kings-Lynne
Pspell	Vlad Krupin
Readline	Thies C. Arntzen
Recode	Kristian Koehntopp
Reflection	Marcus Boerger, Timm Friebe, George Schlossnagle, Andrei Zmievski, Johannes Schlueter
Sessions	Sascha Schumann, Andrei Zmievski
Shared Memory Operations	Slava Poliakov, Ilia Alshanetsky
SimpleXML	Sterling Hughes, Marcus Boerger, Rob Richards
SNMP	Rasmus Lerdorf, Harrie Hazewinkel, Mike Jackson, Steven Lawrance, Johann Hanne, Boris Lytochkin
SOAP	Brad Lafountain, Shane Caraveo, Dmitry Stogov
Sockets	Chris Vandomelen, Sterling Hughes, Daniel Beulshausen, Jason Greene
SPL	Marcus Boerger, Etienne Kneuss
SQLite 3.x driver for PDO	Wez Furlong
SQLite3	Scott MacVicar, Ilia Alshanetsky, Brad Dewar
Sybase-CT	Zeev Suraski, Tom May, Timm Friebe
System V Message based IPC	Wez Furlong
System V Semaphores	Tom May
System V Shared Memory	Christian Cartus
tidy	John Coggeshall, Ilia Alshanetsky
tokenizer	Andrei Zmievski, Johannes Schlueter
WDDX	Andrei Zmievski
XML	Stig Bakken, Thies C. Arntzen, Sterling Hughes
XMLReader	Rob Richards
xmlrpc	Dan Libby
XMLWriter	Rob Richards, Pierre-Alain Joye
XSL	Christian Stocker, Rob Richards
Zip	Pierre-Alain Joye, Remi Collet
Zlib	Rasmus Lerdorf, Stefan Roehrich, Zeev Suraski, Jade Nicoletti, Michael Wallner

PHP Documentation
Authors	Mehdi Achour, Friedhelm Betz, Antony Dovgal, Nuno Lopes, Hannes Magnusson, Georg Richter, Damien Seguy, Jakub Vrana, Adam Harvey, Peter Cowburn
Editor	Philip Olson
User Note Maintainers	Daniel P. Brown, Thiago Henrique Pojda
Other Contributors	Previously active authors, editors and other contributors are listed in the manual.

Websites and Infrastructure team
PHP Websites Team	Rasmus Lerdorf, Hannes Magnusson, Philip Olson, Lukas Kahwe Smith, Pierre-Alain Joye, Kalle Sommer Nielsen, Peter Cowburn, Adam Harvey, Ferenc Kovacs, Levi Morrison
Event Maintainers	Damien Seguy, Daniel P. Brown
Network Infrastructure	Daniel P. Brown
Windows Infrastructure	Alex Schoenmaker