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.