China’s diagnosis-related group payment reform

The Chinese government has been actively promoting the structural reform of its healthcare system. Healthcare payment reform is expected to move ahead quickly with a pilot implementation of multiple social health insurance payment model types.  The country’s National Healthcare Security Administration (NHSA) indicated that it would develop a diagnosis-related group (DRG) standard suited to China’s healthcare system as well as social health insurance management capabilities.

In this article, Milliman consultants Jiang Guanjun and Qiuwen Peng examine the transition from the currently mainstream fee-for-service model to the DRG payment model, the history of DRG in foreign markets, and the potential challenges of having a DRG payment model in China’s system.

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