Using sound Clinical Paths and Diagnosis-related Groups (DRGs)-based payment reform to bring benefits to patient care: A case study of leukemia therapy

Abstract

China has been undertaking a profound reform on health care. Although more than 1.16 billion people have been covered by rural and urban medical insurance to date, the level of reimbursement from insurance is very limited, especially for critical diseases such as leukemia. This places heavy economic burdens on patients. Under these circumstances, systems innovation is imperative for the efficient utilization of limited funding. In this respect, certain valuable experience from other countries may prove helpful. The prospective payment system of Diagnosis-related Groups (DRGs), Clinical Paths, and the Comparative Effectiveness Analysis adopted by the National Institute of Health and Clinical Excellence (NICE, UK), can be fine tools to reduce medical costs and improve quality of services. Treatments of acute promyelocytic leukemia at Rui-Jin Hospital, and childhood acute lymphoblastic leukemia at Shanghai Children’s Medical Center, can be taken as suitable models to illustrate the crucial role of Clinical Paths in guaranteeing clinical and cost effectiveness of medical services for critical diseases, and to satisfactorily justify the feasibility of DRGs in China.

Keywords

healthcare reform / diagnosis-related groups / clinical paths / comparative effectiveness analysis / acute promyelocytic leukemia / childhood acute lymphoblastic leukemia