The average hospitalization cost will fall by 2025, and the reform of medical insurance payment will take effect

The reporter learned from the National Healthcare Security Administration that in 2025, the average hospitalization cost of medical insurance for employees and residents in China will both decrease year-on-year, and the burden of medical treatment for the masses will continue to ease. The dividends of the reform of medical insurance payment methods will continue to be released.

1, The average hospitalization cost has decreased year-on-year, reducing the pressure on the public to seek medical treatment

The data shows that the average hospitalization cost per medical insurance visit for employees nationwide in 2025 will be 11152.69 yuan, a decrease of 4.73% compared to 2024; The average hospitalization cost per medical insurance visit for residents was 7338.49 yuan, a year-on-year decrease of 0.94%. The core driving force behind the cost reduction is the nationwide implementation of the pay per disease reform.

In the past, medical insurance implemented payment by project, with drugs, consumables, and inspection items settled item by item, which easily led to behaviors such as excessive inspections and large prescriptions that wasted medical insurance funds. Since 2019, China has fully implemented payment by disease, grouping and calculating cases with similar diagnosis and treatment plans, setting a unified package payment standard, forcing medical institutions to standardize diagnosis and treatment behavior, and efficiently use medical insurance funds.

2, Pay by disease for full coverage, with fund settlement accounting for nearly 90%

At present, payment by disease has covered all medical insurance pooling areas across the country. By 2025, the settlement of medical insurance funds through this model will reach 915.52 billion yuan, accounting for 89.3% of the total eligible hospitalization funds, an increase of 9.3 percentage points compared to 2024.

The reform and adjustment this time focuses on the settlement rules between medical insurance and hospitals, rather than reducing the medical insurance benefits for insured individuals. It aims to shift from "payment based on diagnosis and treatment process" to "payment based on diagnosis and treatment results".

Continuous optimization of cost structure synchronization: In 2025, the proportion of traditional Chinese medicine consumption in disease payment cases will be 37.49%, a year-on-year decrease of 0.52 percentage points; The proportion of medical service fees was 49.17%, an increase of 1.38 percentage points year-on-year. The diagnosis and treatment technology and the ability to treat difficult and severe illnesses of medical institutions have steadily improved.