Progress and Reflections on Innovative Medical Technologies Payment Mechanism under DRG/DIP Payment in China

Corresponding author: zhang luying, zhangluying@fudan.edu.cn

DOI: 10.12201/bmr.202410.00024

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  Abstract: Objective：To collate the progress of innovative medical technology payment mechanism under DRG/DIP payment in different parts of China, and raise suggestions for policy improvement. Methods：The study analysed policy documents on DRG/DIP payment reform in provinces and municipalities up to April 2024 and conducted in-depth interviews with relevant heads of healthcare security departments in some pilot cities. Results：A total of 45 national DRG/DIP payment reform pilot cities and 19 provincial expansion cities included innovative technology payment mechanisms in the reform documents. The innovative technology payment mechanism for DRG-paying cities includes eight types of practices such as incorporating existing subgroups or adding new subgroups, expert argumentation and deliberation, adjusting subgroup weights/institutional coefficients, separate payment, encouraging tilting towards new medical technologies, and making up the difference in liquidation, etc. The DIP-paying cities are classified into six types of practices such as determining the additive scores after expert deliberation, and determining the scores by adopting different computation rules. The practices of Shanghai, Hangzhou and Nanjing are more typical, namely tilting towards new technologies in supporting industrial development, setting up regressive incentives and precise compensation under a multi-dimensional adjustment mechanism. Conclusion：It is necessary to give a harmonised definition of innovative technologies at the national or provincial level and to complete its access and exit mechanism; using the rebate incentive mechanism helps promote the transition from short-term to long-term payments; adherence to the total amount of control in addition to DRG/DIP payment and improvement of the regulation are important.

  Key words: DRG/DIP payment; innovative medical technologies; payment mechanism; policy analysis

  Submit time: 11 October 2024

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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