Issuance of National Pilot Technical Specification and Plan of Diagnosis Related Group (DRG) and Payment

  • 2019-10-28
On October 16, 2019, the National Healthcare Security Administration issued the Notice on the Issuance of National Pilot Technical Specification and Plan for Diagnosis Related Group (DRG) and Payment (YBBF [2019] No. 36, hereinafter referred to as the Notice), and officially published the Technical Specification of National Healthcare Security DRG and Payment (hereinafter referred to as the Technical Specification) and the Plan for National Healthcare Security DRG (CHS-DRG) (hereinafter referred to as the Plan). The Technical Specification specifies the fundamental principle, range of application, definition of nouns, data demand, data quality control, standardized upload specification, grouping strategy and principle, determination method of weight and rate, etc. The Plan defines the national healthcare security diagnosis related group as the uniform standard for implementing DRG payment by national healthcare security departments, containing 26 major diagnosis categories, 376 core DRGs, which include 167 surgical operation ADRG groups, 22 non-surgical operation ADRG groups and 187 internal medical diagnosis ADRG groups.
CHS-DRG is developed by leading experts in DRG research in China and Chinese Medical Association on the basis of national code for disease diagnosis and surgical operation of healthcare version and combing with the advantages of current major DRG versions, with high authoritativeness, strong compatibility and practicability. Moreover, the Notice requires that all pilot cities should carry out relevant work in accordance with the technical specification and the plan, and achieve the overall pilot and precise localization, making CHS-DRG the common language in the field of national healthcare. It is emphasized that healthcare departments of pilot cities shall apply five information service codes, including healthcare disease diagnosis and surgical operation, medical service items, drugs, medical consumables and healthcare settlement lists, and organize the establishment of information system, personnel training, monitoring and evaluation, intelligent monitoring, etc.