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Print Edition> Forum
UPDATED: July 9, 2010 NO. 28 JULY 15, 2010
Will a 'Diagnosis-Related Group' System Help?

People often consider it is better to sacrifice all they own to keep their life, so once they become seriously ill, they might give all of their property to hospitals if they save their life. This is the worst kind of trade. The DRG system will somewhat control this kind of bad trade.

Liu Kemei (Guangming Daily): Under the DRG system, there is a fixed price for treating patients having the same disease whatever procedures and medications the hospital uses. With such a system, doctors and hospitals will have the incentive to provide cost-efficient and effective treatment while the long-time problem of expensive medical care in China will be alleviated.

Some people worry while the new payment scheme will help patients save money, it could impel doctors to simplify treatment procedures or opt for cheaper and less effective medication. But pilot programs for this system have proved this concern unfounded.

It's reported after the Hospital Affiliated to the Jining Medical Institute in Shandong Province started a pilot program of the DRG system in 2004, average treatment cost has dropped by 33 percent. As one of the first pilot hospitals for the system in Henan Province, the No.1 Hospital of the Xinxiang Medical Institute had handled 1,958 cases under the DRG system by the end of November 2007, which saved patients an estimated total of 590,000 yuan ($86,800). There was not one conflict between hospitals and patients in these cases. Successful pilot programs from different places in China like these best demonstrate the advantages of the DRG system.

Hidden risks

Tang Jun (The Beijing News): Internationally, the implementation of the DRG system means a medical insurance agency will pay a set price to hospitals for each disease requiring in-hospital care after the patient receives effective treatment. The payment doesn't alter with length, procedures or costs of medical care.

In theory, it sounds like ordering food at a restaurant. The customer orders a dish he or she wants and doesn't have to worry about cooking procedures. The bill will be paid if the dish suits the palate. But the practice of medicine is much more complicated than cooking food.

A medical insurance agency is supposed to pay a fixed price for a medical condition if the patient is effectively treated. Defining the effective treatment of a patient is more complex than commenting on food. There must be clear criteria on the effective treatment of patients and standard procedures to deal with cases where patients die during treatment.

Another hidden risk of introducing the DRG system is that it might affect the quality of medical care. If every disease or condition has a fixed price, hospitals won't be interested in adopting new technologies. They might refuse to take in patients with more serious conditions or intentionally misdiagnose minor conditions like a cold as pneumonia to charge more. To prevent this, medical insurance agencies must send professional personnel to supervise the practices of hospitals at all times and also take every means possible to prevent the supervisors from becoming corrupt.

There is no universally acknowledged best health insurance system and the effectiveness of the DRG system has yet to be tested by time.

Jia Rujun (hlj.rednet.cn): The DRG system is a little bit like "contracting engineering projects." When the total budget of a project is fixed, contractors are tempted to drive down the costs by reducing the use of materials or manpower. We cannot help suspecting if the same situation will occur in hospitals and whether doctors will use cheaper and less effective medication on patients or discharge patients from the hospital before they have fully recovered.

The DRG system is designed to control the treatment cost with a single disease and no complications. But what should a surgeon do if he finds a tumor in a patient's abdomen during an appendectomy? Should the surgeon stop the operation to explain the extra costs to the patient or the hospital first? Without regulating all possible situations, introducing this system could give rise to a higher degree of conflict between patients and hospitals.

The media say the DRG system has been implemented in many countries as an effective method of guaranteeing medical cost effectiveness. Since people in China have been complaining about difficult access to medical treatment and heavy costs for a long time, we should try any method likely to solve the problem. But before we put any new scheme into practice, we must first consider whether it suits China's particular conditions. After all, our market-oriented health care reform, which was also adopted from other countries, has proved a failure. We cannot afford another round of failed reforms.

Many schemes proved effective in other countries turn out to be ineffective in China. This might have told us that when learning from the health care reform experience of other countries, we also need to study these countries' advanced legal systems and effective management systems and schemes for our benefit.

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