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.
Similar content being viewed by others
References
Guidelines for Deepening Health-care Reform. State Council of China. http://news.xinhuanet.com/newscenter/2009-04/07/content_11142999_1.htm (in Chinese)
Action Plan for Healthcare Reform in 2009–2011. State Council of China. http://news.xinhuanet.com/newscenter/2009-04/07/content_11142999_1.htm (in Chinese)
Announcement issued on the official website of the Ministry of Health of China on Aug. 10, 2009. http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s6717/200908/42282.htm (in Chinese)
News release by the Office of Healthcare Reform Steering Team, State Council of China on Aug. 8, 2009. http://finance.people.com. cn/GB/9815328.html (in Chinese)
Chen Z. Launch of the health-care reform plan in China. Lancet, 2009, 373(9672): 1322–1324
Mayes R. The origins, development, and passage of Medicare’s revolutionary prospective payment system. J Hist Med Allied Sci, 2007, 62(1): 21–55
Reid B, Sutch S. Comparing diagnosis-related group systems to identify design improvement. Health Policy, 2008, 87(1): 82–91
Diagnosis Related Groups (DRGs) and the Medicare program: implications for medical technology a technical memorandum. Washington D.C.: US Congress, Office of Technology Assessment, OTA-TM-H-17. 1983
Levit K R, Freeland S. National medical care spending. Health Aff, Winter 1988, 124–136
Pearson S D, Goulart-Fisher D, Lee TH. Critical pathways as a strategy for improving care: problems and potential. Ann Intern Med, 1995, 123(12): 941–948
Audimoolam S, Nair M, Gaikwad R, Qing C. The Role of Clinical Pathways in improving patient outcomes. http://torch.cs.dal.ca/∼asharma/OWL/Role%2520of%2520Clinical%2520Pathways.pdf
Weiland D E. Why use clinical pathways rather than practice guidelines? Am J Surg, 1997, 174(6): 592–595
Rotter T, Kugler J, Koch R, Gothe H, Twork S, van Oostrum J M, Steyerberg E W. A systematic review and meta-analysis of the effects of clinical pathways on length of stay, hospital costs and patient outcomes. BMC Health Serv Res, 2008, 8: 265
Rouse A D, Tripp B L, Shipley S, Pories W, Cunningham P, MacDonald K Jr. Meeting the challenge of managed care through clinical pathways for bariatric surgery. Obes Surg, 1998, 8(5): 530–534
Dowsey M M, Kilgour M L, Santamaria N M, Choong P F. Clinical pathways in hip and knee arthroplasty: a prospective randomised controlled study. Med J Aust, 1999, 170(2): 59–62
Birch S, Gafni A. On being NICE in the UK: guidelines for technology appraisal for the NHS in England and Wales. Health Econ, 2002, 11(3): 185–191
Raftery J. NICE: faster access to modern treatments? Analysis of guidance on health technologies. BMJ, 2001, 323(7324): 1300–1303
Cheng T M. Medical service quality standards: experiences of the UK’s NICE. Presented at the Conference on Health Reform: Global Healthcare Reform Experiences. 2009
Phillips C. What is a QALY? London: Hayward Medical Communications. 2009
Wu G H. DRGs’ development and related research in China. Zhongguo Yiyuan Guanli, 2007, 27(7): 10–12 (in Chinese)
Announcement of the launching of the pilot program of clinical paths. Bulletin on the Website of the Ministry of Health. Dec. 8, 2009. http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohyzs/s3585/200912/44858 (in Chinese)
Shen Z X, Shi Z Z, Fang J, Gu B W, Li J M, Zhu Y M, Shi J Y, Zheng P Z, Yan H, Chen Y, Shen Y, Wu W, Tang W, Waxman S, de Thé H, Wang Z Y, Chen S J, Chen Z. All-trans retinoic acid/As2O3 combination yields a high quality remission and survival in newly diagnosed acute promyelocytic leukemia. Proc Natl Acad Sci USA, 2004, 101(15): 5328–5335.
Hu J, Liu Y F, Wu CF, Xu F, Shi Z X, Zhu Y M, Li J M, Tang W, Zhao W L, Wu W, Sun H P, Chen Q S, Chen B, Zhou G B, Zelent A, Waxman S, Wang Z Y, Chen S J, Chen Z. Long-term efficacy and safety of all-trans retinoic acid/arsenic trioxide based therapy in newly diagnosed acute promyelocytic leukemia. Proc Natl Acad Sci USA, 2009, 106(6): 3342–3347
Liu Y, Chen J, Tang J Y, Ni S X, Xue H L, Pan C. Cost of childhood acute lymphoblastic leukemia care in Shanghai, China. Pediatr Blood Cancer, 2009, 53: 557–562
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhang, ZR., Mi, JQ., Gu, LJ. et al. Using sound Clinical Paths and Diagnosis-related Groups (DRGs)-based payment reform to bring benefits to patient care: A case study of leukemia therapy. Front. Med. China 4, 8–15 (2010). https://doi.org/10.1007/s11684-010-0018-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11684-010-0018-5