China amends group medical insurance payment system pilot program

A new medical insurance payment system piloted in China since October 2019 is being refined to better standardize the way the scheme is carried out, the National Medical Products Administration (NMPA) has announced.

The plan, the diagnosis-related group pilot payment system (DRG), classifies patients into groups with similar clinical symptoms and resource costs based on their age, gender, length of stay, and clinical diagnosis. The changes to the plan call for sorting patients into 618 diagnosis-related groups instead of the 376 called for in the original pilot plan.

The existing model in Chinese hospitals is cost-based. Patients are charged for examinations, surgeries, and other treatments based on the cost of medical equipment and human resources. Under the DRG model, medical fees and insurance payments are determined by the DRG classification instead of varying according to individual cases.

The pilot program is being carried out in 30 cities, including Beijing, Tianjin, and Handan in China’s Hebei province.

The DRG model is designed to cut down on unnecessary treatment and the overuse of medicines, devices, and examinations. In addition to refining how patient ailments are classified under the plan, the changes announced by the NMPA will also set out norms for the standardized collection and use of basic medical data.

All pilot cities must submit an evaluation report to the national DRG-style payment technical guidance group before August 31 and begin to carry out DRG payments simulations following plan approvals.