推进日间手术医保支付方式改革是优化医保基金使用效率、提升医疗服务体系效能的重要举措。本文基于2016—2025年全国范围内发布的65份地方政策文本,运用政策文本分析法,从政策脉络、层级结构、主体协同及支付方式等多维度系统剖析我国日间手术医保支付政策的发展特征。研究表明,我国日间手术医保支付政策呈现“局部试点—逐步扩散—全面深化”的演进路径;政策体系呈现金字塔形层级分布,形成省级统筹、地市细化的推进机制;在政策主体上,构建了医保部门主导、卫生健康部门协同、多部门参与的治理架构;支付方式与待遇标准呈现多元化态势。然而,当前改革仍面临政策体系碎片化、跨部门协同机制不畅、医保支付的制度性激励不足等挑战。为此,应进一步强化顶层设计与制度整合,建立常态化跨部门协同机制,构建体现技术劳务价值的激励性支付体系,并加快日间手术医保管理信息平台建设,从而系统推进日间手术医保支付体系的标准化、规范化与高质量发展。

Reforming medical insurance payment methods for day surgery represents a critical policy initiative to improve the efficiency of medical insurance fund utilization and enhance the performance of healthcare service delivery. Based on 65 local policy documents issued across China from 2016 and 2025, this study conducts a policy text analysis to systematically examine the development of day surgery medical insurance payment policies from multiple dimensions, including policy evolution, hierarchical structure, inter-departmental collaboration, and payment mechanisms. The findings indicate that China’s day surgery medical insurance payment policies have evolved through three distinct phases: localized piloting, gradual diffusion, and comprehensive deepening. The policy architecture exhibits a pyramidal structure, with provincial-level coordination guiding municipal-level implementation. In terms of governance, a collaborative mechanism has taken shape, featuring leadership by healthcare security administrations, coordination by health commissions, and participation by multiple departments. Payment methods and benefit standards demonstrate considerable regional diversity. Nevertheless, several challenges persist, such as policy fragmentation, ineffective inter-departmental coordination, and insufficient incentives under the medical insurance payment system. To address these issues, this study proposes strengthening top-level design and institutional integration, establishing formalized cross-departmental collaboration mechanisms, developing incentive payment systems that fully reflect technical and labor contributions, and accelerating the construction of information platforms for day surgery medical insurance management. These measures are essential for advancing the standardization, systematization, and high-quality development of China’s day surgery insurance payment system.