The National Healthcare Security Administration (NHSA) in China has issued a notification outlining several updates to the Diagnosis Related Groups (DRG)/Diagnosis-Intervention Packet (DIP) hospital payment reform program. The new guidance mandates that regions which have not yet initiated DRG/DIP payment reforms must adopt the 2.0 version immediately, while regions that have established DRG/DIP payments under the previous system have until December 31, 2024, to transition to the 2.0 version.
The notification calls for provincial health authorities to align their local groupings with the national standard ADRG and national DIP disease grouping rules. Regions are urged to expedite the annual fund repayment process, ensuring all outstanding payments are settled by the end of June in the following year. Monthly settlements should be optimized to improve efficiency, with the cost settlement time not exceeding 30 working days from the day after the declaration deadline.
Medical institutions are expected to provide regular and comprehensive feedback on DRG/DIP enrollment and settlement, refraining from using DRG/DIP payment standards in medical personnel performance allocation indicators. Local HSA bureaus, in consultation with local finance departments, are encouraged to prepay approximately one month’s advance payment to designated medical institutions to alleviate financial pressures.
Hospitals are allowed to seek exclusion for cases not suitable for DRG/DIP payment standards, such as those involving long hospitalization times, high medical expenses, new drugs or technologies, complex critical illnesses, or multidisciplinary joint diagnosis and treatment. The number of patients in such cases should generally not exceed 5% of total DRG or DIP cases. Hospitals can apply for exemptions to regional authorities, which will handle review and evaluation. Based on expert opinions, project payment or adjustment of payment standards may be implemented on a case-by-case basis. Announcements regarding special cases will be made in July 2025 and every six months thereafter. The exclusion mechanism will be explored to support new drugs and technologies through project payment or weighting bonuses in the early stages of application. Once sufficient data is accumulated, these will be incorporated into the DRG/DIP payment system.
Furthermore, the document encourages provinces to explore the inclusion of out-of-province medical expenses in DRG/DIP management. It suggests involving representatives of insured persons in the negotiation process and establishing an expert group on medical insurance payment method reforms. Coordinated regions are encouraged to form a ‘medical insurance data working group’ consisting of at least 8 representatives from various levels and types of medical institutions, with members rotated and adjusted annually. The coordination of medical insurance and healthcare reform will be intensified.- Flcube.com
