As an efficient and cost-effective medical service model, day surgery has been widely adopted in developed countries, where it has evolved into a mature system. Although day surgery in China is gradually entering a phase of standardized development, its medical insurance payment system still needs further improvement in terms of payment standards, payment rules, the degree of correlation with actual clinical costs, and the quality evaluation system. From an international perspective, this study selects four developed countries with well-established day surgery systems—the United Kingdom, the United States, Germany, and Singapore—as case studies. It focuses on a comparative analysis of the institutional logic behind their day surgery medical insurance payment systems and systematically explores the top-level design and operational mechanisms in these countries, to provide targeted theoretical references and practical suggestions for building the institutional framework and optimizing the rules of China’s day surgery medical insurance payment system.
Key words
day surgery /
medical insurance payment system /
institutional logic /
international comparison /
medical insurance policy
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References
[1] JACKSON I.Day surgery overview: where are we now, how did we get here and where are we going?[J]. Current anaesthesia & critical care, 2007, 18(4):176-180.
[2] 马洪升,戴燕.日间手术治疗模式国内外发展简述[J].中国医院管理,2012,32(01):47-48.
[3] 房良,曹建文,王盟,等.不同医疗保险模式国家日间手术开展情况的比较研究[J].中国医院,2014,18(10):78-80.
[4] ALVAREZ A, MAYS N.Understanding NHS policy making in England: the formulation of the NHS plan, 2000[J]. The British journal of politics and international relations, 2014, 16(4):624-644.
[5] 张晓瑜,廖藏宜.典型国家DRG异化行为监管比较研究及启示[J].中国医疗保险,2023(09):32-39.
[6] NHS Department of Health Payment by Results team. A simple guide to Payment by Results [EB/OL]. (2012-11-01) [2025-11-27]. https://assets.publishing.service.gov.uk/media/5a7c6875e5274a5590059a9f/PbR-Simple-Guide-FINAL.pdf.
[7] NHS Department of Health Payment by Results team. Payment by Results guidance for2010-11 [EB/OL]. (2014-09-12) [2025-11-27]. https://data.parliament.uk/DepositedPapers/Files/DEP2010-1594/DEP2010-1594.pdf.
[8] The Professional Association for Healthcare Finance. HFMA introductory guide to NHS finance Chapter 16: How providers of NHS services are paid [EB/OL]. (2023-11-07) [2025-11-27]. https://www.hfma.org.uk/system/files/chapter-16—HFMA-introductory-guide-to-nhs-finance.pdf.
[9] BRITTEON P, KRISTENSEN SR, LAU Y-S, et al.Spillover effects of financial incentives for providers onto non-targeted patients: daycase surgery in English hospitals[J]. Health economics, policy and law, 2023, 18(3): 289-304.
[10] NHS England. National Cost Collection for the NHS [EB/OL]. (2023-11-07) [2025-11-27]. https://www.england.nhs.uk/costing-in-the-nhs/national-cost-collection/.
[11] The Professional Association for Healthcare Finance. Cost mapping [EB/OL]. (2023-11-07) [2025-11-27]. https://www.hfma.org.uk/system/files/cost-mapping.pdf.
[12] NHS England.2023/25 NHS payment scheme annex A: 2024/25 prices workbook (2024) [EB/OL]. (2023-03-23) [2026-04-27]. https://www.england.nhs.uk/wp-content/uploads/2023/03/23-25NHSPS_Annex-A_2024-25.xlsx.
[13] NHS England. NHS Payment Scheme [EB/OL]. (2023-11-07) [2025-11-27]. https://www.england.nhs.uk/pay-syst/nhs-payment-scheme.
[14] United States Government Accountability Office. Payment for ambulatory surgical centers should be based on the hospital outpatient payment system [EB/OL] (2006-11-30) [2025-11-25]. https://www.gao.gov/assets/gao-07-86.pdf.
[15] Centers for Medicare & Medicaid Services. Physician fee schedule [EB/OL] (2024-11-25) [2026-05-06]. https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/physician-fee-schedule.
[16] GKV-Spitzenverband. Ambulantes Operieren 115 b [EB/OL] (2025-01-01) [2025-03-12]. https://www.gkv-spitzenverband.de/krankenversicherung/ambulant_stationaere_versorgung/ambulantes_operieren_115_b/ambulantes_operieren_115_b.jsp.
[17] Med Tech Reimbursement Consulting. The Hybrid DRG Reimbursement Agreement for2025 has been approved in Germany [EB/OL]. (2025-01-01) [2026-03-01]. https://mtrconsult.com/news/hybrid-drg-reimbursement-agreement-2025-has-been-approved-germany.
[18] World Health Organization Regional Office for Europe. Health care systems in transition: Germany [EB/OL]. (2004-01-01) [2025-11-25]. https://iris.who.int/handle/10665/108301.
[19] KBV. Eingriffe mit Hybrid-DRG: Prä- und postoperative Leistungen nach EBM abrechenbar [EB/OL] (2024-09-04)[2025-03-18].https://www.kbv.de/html/1150_68598.
[20] PIOCH C, BUSSE R, MANSKY T, et al.The potential for performing procedures on an outpatient rather than inpatient basis: a nationwide analysis of hospital discharge data in Germany for the year 2022[J]. Deutsches Ärzteblatt international, 2025, 122(6):151-155.
[21] KISCH T, MUELLER-RATH R, GREGOR S, et al.Hybrid-DRGs - Die Herausforderung[J]. Die Chirurgie, 2024, 95(12): 1007-1011.
[22] OTTENBACHER K J, KARMARKAR A, GRAHAM J E, et al.Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service medicare patients[J]. JAMA, 2014, 311(6): 604.
[23] 俞德梁,刘小南,宁鹏涛.中国日间手术政策演变及对医疗决策发展的启示[J].医学与哲学,2016,37(6b):4-7.
[24] 张晨曦,王海银,刘昕,等.基于HTA的医疗服务项目医保准入机制国际实践与启示[J].中国卫生经济,2024,43(09):92-96.
[25] Ministry of Health Singapore. Hospital bills and fee benchmarks(2025) [EB/OL]. (2025-01-01)[2025-03-01]. https://www.moh.gov.sg/managing-expenses/bills-and-fee-benchmarks/hospital-bills-and-fee-benchmarks/.
[26] 张欣桐,吕兰婷.新加坡多层次医疗保障体系特点及启示[J].中国医疗保险,2024(11):117-125.
[27] 国家卫生健康委.关于印发2023年度全国三级公立医院绩效监测分析情况的通报[EB/OL].(2025-03-10)[2026-05-14].https://www.nhc.gov.cn/yzygj/c100067/202503/5afa3c26abf6461ba02bf0f3997d821e.shtml.
[28] 丁玉兰,方黎芬,陈亚丹.某三甲医院日间手术开展对缩短患者住院天数的效应分析[J].中国卫生标准管理,2017,8(15):20-22.
[29] 余擎,赵敏,苏晓洁.日间手术管理对平均住院日及住院费用的影响——基于中断时间序列分析[J].中国现代医生,2024,62(12):101-103+108.
[30] 于丽华. 中国日间手术发展的历程与展望[J].中国医院管理,2016,36(06):16-18.
[31] 嵇武,刘亚萍,戴玮.我国日间手术开展现状与前景展望[J].中国实用外科杂志,2020,40(02):199-202.
[32] 李海鹏,葛锋.日间手术存在的问题与优化策略探讨[J].中国医院管理,2022,42(06):64-66.
