Tag Archives: Medical service

China’s NHSA Launches Work Plan for First National Medical Insurance Medical Service Catalogue – 13 Clinical Categories in Batch One Reshape Reimbursement Rules for Providers Nationwide

Policy Snapshot

Item	Detail
Authority	National Healthcare Security Administration (NHSA), China
Document	Work Plan for Formulating the First Batch of the National Basic Medical Insurance Medical Service Item Catalogue
Release Date	16 September 2026
Legal Basis	Healthcare Security Law of the PRC; CPC Central Committee & State Council Opinions on Deepening Healthcare Security System Reform; 1999 MOHRSS rules on diagnostic/treatment item management
First Batch Scope	13 categories (incl. related items in other categories), to be expanded in batches alongside the national medical service price project listing guidelines
Initial Application	Cross‑province direct settlement for out‑of‑town treatment; subsequently linked with provincial insurance payment scopes

Inclusion & Exclusion Criteria

Inclusion Baseline: Items must be listed in the current national medical service price project listing guidelines (trial), be clinically necessary, safe, effective and appropriately priced, and pose controllable impact on basic medical insurance fund expenditure without threatening fund security.
Explicit Exclusions: Items subject to market‑regulated pricing; non‑disease‑treatment services such as cosmetic procedures, weight loss, health checkups, prevention and wellness; services with insufficient clinical application, uncertain efficacy, or major safety risks; and anything else outside the basic insurance coverage scope.
Guiding Principle: The catalogue adheres to the “basic coverage” positioning of basic medical insurance — acting within capability, keeping total volume stable, and ensuring smooth transition, weighing fund affordability, clinical demand and social impact.

Work Program – Three Phases

Preparation Phase: Establish a dedicated task force and expert database; finalize work rules covering integrity, confidentiality and conflict‑of‑interest recusal; collect provincial data on price‑listing implementation, service pricing and payment status; and run fund modeling on the first batch’s insurance expenditure and the overall national cost envelope for medical services.
Review Phase: A survey across representative medical institutions at all levels in 31 provinces (regions, municipalities) plus the Xinjiang Production and Construction Corps; joint review by management and clinical experts scoring each item on inclusion merit, health benefit, clinical need, equity and cost‑effectiveness; expert discussion of restricted payment scopes; and a fund impact assessment with local insurance authorities before shortlisting items.
Publication Phase: The first‑batch catalogue is finalized based on expert opinions and fund impact modeling, submitted for approval per procedure, then issued to guide local implementation.

Governance & Expert Oversight

Expert Composition: Reviewers — insurance management, price management, health economics/HTA and clinical experts — are recommended by relevant departments or randomly drawn from the expert pool, with geographic balance, representation across institution types and tiers, and inclusion of primary‑care institution representatives.
Clinical Reviewer Scope: Clinical experts evaluate items only within their specialty fields.
Supervision Mechanisms: Disciplinary inspection and supervision bodies are invited to oversee preparation, review and publication; internal controls mandate role accountability, confidentiality, recusal and liability rules; experts sign non‑disclosure agreements, must commit to impartial service, are barred from unauthorized public activity in the catalogue‑expert capacity, and all proceedings are fully documented to preserve independence.

Market Impact & Outlook

Reimbursement Architecture: A unified national service catalogue replaces the current patchwork of provincial coverage lists — a structural shift for hospitals’ revenue predictability and for cross‑province settlement efficiency serving China’s large migrant population.
Provider Strategy: Medical institutions should map their service portfolios against the 13 first‑batch categories and the inclusion criteria, anticipating which items may face restricted payment scopes or exclusion as market‑priced services.
Sector Winners & Watchpoints: Categories inside the catalogue — notably dental implants, assisted reproduction, rehabilitation and radiotherapy — gain clearer reimbursement visibility, while cosmetic, wellness and weight‑loss services are explicitly ring‑fenced outside basic insurance.
Phased Expansion: Subsequent batches will follow the rollout of national price project listing guidelines, signaling a multi‑year build‑out toward full national standardization of insured medical services.

Forward‑Looking Statements
This brief contains forward‑looking statements regarding the formulation, approval and implementation of China’s national medical insurance medical service item catalogue. The work plan remains subject to consultation, expert review and fund impact assessment; the final catalogue composition, payment restrictions, effective dates and local implementation may differ materially from current expectations.-China Health Reform Pulse

Policy Source: https://ylbz.gansu.gov.cn/ylbzj/c105248/202609/174394881.shtml

Henan Proposes Standardizing and Consolidating Medical Services Pricing Items Across Four Clinical Categories – Public Consultation Open Through 17 September, With Parallel Cancellation Lists

Policy Milestone

Item	Detail
Issuing Agency	Henan Provincial Healthcare Security Administration – Department of Medical Commodity Pricing and Tender Procurement
Announcement Date	11 Sep 2026
Policy Basis	NHSA and seven other departments’ Notice on Issuing the Pilot Program for Deepening Medical Service Price Reform (Yi Bao Fa [2021] No. 41); NHSA project‑establishment guidelines for medical service price items
Scope	Standardization and consolidation of price items across digestive system; vascular & lymphatic system; maxillofacial surgery; general treatment categories
Dual Structure	Eight attachments: 4 consolidation drafts + 4 cancellation drafts (one pairing per category)
Comment Deadline	Before 17 September 2026 – written submission or electronic scan, bearing organizational seal or personal signature
Contact	Tel: 0371‑69690434; Email: hnsybjjgzc@126.com

Standardization & Consolidation Framework

Two‑Track Restructuring: For each of the four categories, the Administration has prepared both a draft of standardized/consolidated price items (Attachments 1–4) and a draft list of price items proposed for cancellation (Attachments 5–8) – signaling a deliberate slimming of Henan’s fragmented local price‑item catalog.
Category Pairing: Vascular and lymphatic system services are handled together as a single consolidated category, alongside digestive system, maxillofacial surgery and general treatment items.
National Guidelines Alignment: The restructuring implements the NHSA’s project‑establishment guidelines (立项指南) for medical service price items – part of the nationwide campaign to unify locally defined, inconsistently named service items under standardized national categories.
Pricing Reform Pilot Lineage: The plan operationalizes the 2021 eight‑department price reform pilot framework, which shifted the policy focus from item‑by‑item price adjustment toward structural standardization of what hospitals may charge and bill.
Draft Content: Specific item names, mappings and price levels are set out in the eight attachments and were not disclosed in the public notice itself.

Public Consultation Requirements

Eligible Submitters: Any organization or individual.
Format: Comments must be submitted in writing or as electronic scans to the Administration’s Department of Medical Commodity Pricing and Tender Procurement.
Authentication: Submissions must bear the official seal of the organization or the personal signature of the submitter; feedback is due before 17 September 2026.

Market Impact & Outlook

Catalog Rationalization: Consolidation paired with explicit cancellation lists will compress Henan’s billable service menu, eliminating overlapping, outdated or fragmented charge items – a prerequisite for transparent, comparable pricing across hospitals.
Hospital Billing Impact: Providers will need to remap billing systems and internal charge masters to the new standardized items, with abolished items requiring migration to consolidated equivalents.
National Convergence Signal: As more provinces issue guideline‑based restructuring drafts, Henan’s move reinforces the trajectory toward nationally uniform medical service price items, reducing cross‑province variation in how identical procedures are named and priced.
Price‑Level Uncertainty: The notice covers item standardization and consolidation, not the setting of new price levels; any subsequent price adjustments would follow separate provincial processes – details not disclosed.
Tight Window: The roughly six‑day comment period suggests the Administration intends to finalize the restructured catalog on a compressed timeline.

Forward‑Looking Statements
This brief contains forward‑looking statements regarding the finalization and implementation of Henan Province’s standardized and consolidated medical services pricing items. Actual outcomes may differ due to risks including public feedback, revisions to draft consolidation and cancellation lists, national guideline updates, and provincial implementation timing. The drafts remain subject to revision and do not constitute final policy.-China Health Reform Pulse

Policy Source: http://ylbz.henan.gov.cn/2026/09-11/3418603.html

Shanxi Clarifies Medical Service Pricing Rules for Public Hospitals

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Taiyuan, Sept 7, 2026 — The Shanxi Provincial Medical Security Bureau has issued a formal interpretation of its medical service pricing policy (Notice No. 9 of 2026), setting out detailed billing rules for public medical institutions across ten areas—from price-item design and “service output” definitions to surcharge stacking, pricing units and the separation of consumables from clinical services.

Policy Snapshot

Attribute	Detail
Document	Interpretation of Price Policy for Medical Service Projects
Reference	Shanxi Medical Security Bureau Notice No. 9 of 2026
Issuing body	Shanxi Provincial Medical Security Bureau
Date	Sept 7, 2026 (proactively disclosed)
Scope	Billing and price-item application across public medical institutions in Shanxi
Core principle	Price items anchored to “service output,” not to devices or consumables
Key reforms	Separation of technology and consumables (“技耗分离”); separation of drugs and consumables (“药耗分离”)

Policy Context

The interpretation clarifies how hospitals should apply China’s new project-establishment guidelines for medical service prices. Under the framework, price items are created only where a distinct clinical service output exists: identical outputs from different techniques or pathways must map to a single item, complete procedures cannot be unbilled into steps, and no item may be established around a device or consumable—for instance, arrhythmia ablation is priced as one item regardless of whether radiofrequency, cryo, chemical or pulsed-field energy is used.

The document defines service output across four dimensions—core clinical outcomes, tangible auxiliary outputs such as test reports, patient-experience outputs, and auxiliary operations billed under an “A+B” (procedure plus add-on) model—and lays out anti-duplication rules with concrete examples: CT plain and enhanced scans may stack only when both are actually performed; ICU nursing fees already embed oral and perineal care; manual release cannot be billed alongside same-site traditional Chinese medicine tuina massage.

On pricing units, the bureau details per-session, per-site and progressive-base calculations—ambulance transport charges a base fare covering 4 kilometers plus 3 yuan per additional kilometer, while nerve-block anesthesia bills a two-hour base of 379 yuan plus 149 yuan per additional hour. Surcharge items within the same sequence cannot stack, though cross-sequence surcharges (for example, chief-physician and pediatric add-ons) may combine. The pediatric surcharge applies strictly through age six—until the day before a child’s seventh birthday—and “newborn” items are limited to the first 28 days of life.

Market Impact Analysis

The interpretation operationalizes one of the most consequential shifts in China’s healthcare payment system: the “separation of technology and consumables” principle, which purifies service prices to reflect clinical labor value while making consumable prices explicit and independently managed. By decoupling medical consumables from service items, the policy ends the legacy rule that “no service item, no consumable charge,” laying groundwork for a provincial medical insurance consumables catalog and extending drug-pricing tools—volume-based procurement and catalog management—to devices and disposables.

For hospitals, the document functions as a compliance manual: it resolves recurring billing ambiguities (whether examination fees may be layered onto consultation fees, how mapping items fold into price composition, when re-performed procedures may be billed again) that directly affect revenue integrity under medical insurance audits. The explicit anti-duplication and “basic material consumption” rules—where inclusive but non-analogical interpretation bars separate billing for items like soda lime while allowing distinct high-value devices such as pulse lavage systems—signal tighter scrutiny of unbundling practices.

Provincial-level guidance of this granularity is also a bellwether: as national project-establishment guidelines roll out across China, other provinces are expected to publish similar interpretations, making Shanxi’s framework a reference point for hospital billing systems, medical insurance enforcement and health-economics planning nationwide.

Forward-Looking Statement

Public medical institutions in Shanxi are expected to align billing systems, staff training and internal audit procedures with the interpretation immediately, as the document serves as the operational basis for price execution and insurance fund supervision. Market watchers will monitor whether the clarifications accelerate adoption of the standalone consumables pricing system and how the “service output” consolidation approach shapes future pricing of emerging technologies—including AI-assisted diagnostics and xenotransplantation, which the document already flags as non-separately-billable extensions of existing items. Similar interpretations from other provincial medical security bureaus are anticipated as the national pricing reform deepens toward mid-2027.-China Health Reform Pulse

Policy Source: https://ybj.shanxi.gov.cn/xxfb/xxgkml/202609/t20260907_10215759.html