China pilots new model of medical insurance payment

BEIJING — The National Healthcare Security Administration has issued two key technical documents for a pilot project that introduces diagnosis-related groups (DRGs), a patient classification to standardize payment in the national medical insurance schemes.

The documents were a technical standard and a detailed classification plan for installing the DRGs in China, the administration said in a press release on Oct 24.

The existing model in Chinese hospitals is cost-based. It means that patients are charged with examinations, surgeries and other treatments based on the cost of medical equipment and human resources and the bills will vary according to individual cases.

Under the DRG model, patients will be classified into DRGs with similar clinical symptoms and resource costs on the basis of their age, gender, length of stay and clinical diagnosis. Medical fees and insurance payments will thus be based on DRG classification instead of specific patients.

According to the pilot classification plan, patients will be sorted into 26 major diagnostic categories and 376 adjacent diagnosis-related groups.

China plans to launch the pilot project in 30 cities, including Beijing, Tianjin and Handan in northern China's Hebei province.

The classification plan will be tested in a pool of more than 62 million cases in these cities so that it can be more precise and pragmatic, the administration said.

The DRG model may help prevent excessive treatment and overuse of medicines and examinations, said Zheng Jie, an official with Beijing's healthcare security department.