Pharmaceutical News
Phase 3 DRGs system to take effect from next year

Reported by Huang Hsin-Wen


The 3rd Phase of the DRGs system is to take effect from next January.  The NHIA hopes that some new regulations will prevent hospitals from turning severe cases away for fear that the actual cost might exceed the NHI reimbursement.  At present, the NHIA only reimburses 80% of the treatment cost in excess of the NHI reimbursement.  There will be an improvement next year.  The NHIA will give full reimbursement to some medical devices, including pacemakers, stents and artificial joints.


Pang Yi-Ming, a section chief of the BoMA, expressed that under the current DRGs system, there is a ceiling payment for each type of treatment or surgery where the DRGs is applicable.  Any cost in excess of the ceiling payment will be reimbursed at a discount rate of 80%.  This regulation has been severely criticized by hospitals, saying that it is unreasonable to request hospitals to save lives and pick up the bill.  Patients with complicated conditions are very likely to be rejected by hospitals, warned doctors.


According to Pang Yi-Ming, the NHIA’s data showed that, in 2014, the average hospitalization days were 4.23 days; the referral rate on the day of discharge was 0.7%; and the A&E admission rate in 3-day from discharge was 2.1%.  All figures were lower than those in the previous year.


Pang said that the DRGs system was introduced in 2010.  Its scope will be extended from 401 items to 1062 items next year.  It will cover about 60% of all medical treatments.  About 2.2 million patients will be affected.


In addition to an extended scope, the new DRGs system will give full reimbursement to some special medical devices, including pacemakers, stents and artificial joints.  Taking a pacemaker for example, the surgery fee is about NT$40,000; but a device costs from NT$100,000 to NT$400,000.  However, patients should not have the fallacy that expensive devices are better ones.  They all have their own functions and purposes.  Patients should choose the one that suits their conditions most. 


The NHIA will continue to communicate with all stakeholders and hear their comments on the DRGs system.  The NHIA will allocate some of the 2016 Global Budget to the full implementation of the DRGs system.


【2015-09-10/ China Daily News】