21 Health Daily | NHSA Responds to Concerns Over Hospitals Avoiding Complex Cases Post-DRG Reform; 11 New COVID-19 Deaths Reported Last Month

Source: 21st Century Economic Report

●After the DRG reform, hospitals are afraid to admit complex patients, and inpatients are required to be transferred due to exceeding cost limits? The National Healthcare Security Administration responds

Recently, some doctors have reported that after the implementation of Diagnosis-Related Groups (DRG) payment reform, hospitals, fearing financial losses, are reluctant to admit patients with complex conditions; meanwhile, some netizens have claimed that their relatives, who had been hospitalized for less than 15 days, were forced to be transferred to another hospital by several hospitals on the grounds that "the medical expenses had exceeded the DRG reimbursement cap."

After receiving the netizen's message transferred by the Chinese Government Website, the National Healthcare Security Administration carefully studied and processed it, and issued a public response.

The National Healthcare Security Administration (NHSA) stated in its response that DRG/DIP are specific forms of payment by disease category. Compared with traditional single-disease payment, they can significantly expand the range of covered diseases, enhance management precision, and effectively control fund risks. During the DRG/DIP pilot programs, a set of technical specifications, grouping schemes, and operational procedures were established. Regions across China have continuously improved various mechanisms such as core element adjustments, performance evaluations, dispute resolution, and total budget management. Meanwhile, with the implementation of standardized coding for medical insurance information services, the quality of medical insurance settlement lists and related data reporting in pilot areas has significantly improved.

DRG/DIP Reform Continues to Make Strides in Efficiently Utilizing the "Lifeline Funds" of Insured Individuals, Demonstrating the Leverage Effect of Medical Insurance. A Key Step Has Been Taken in Guiding the Coordinated Development of Medical Insurance, Healthcare, and Pharmaceuticals. In Regions Implementing Actual Payments, the Burden on Individuals Has Generally Decreased, and the Uniform Pricing for Local Disease Categories Has Improved the Convenience of Access to Medical Care for the Public. The Medical Insurance Department Uses Scientific Management Tools to Guide Medical Institutions in Improving Medical Record Quality and Strengthening Clinical Pathway Management. In Practice, Some Medical Institutions Have Relatively Coarse Management, Directly Treating the Average Cost of Disease Categories as the Maximum "Limit," Damaging the Income of Medical Staff and the Medical Rights of Insured Individuals. Relevant Situations Should Be Promptly Reported to the Medical Insurance Department, and Local Medical Insurance Departments Will Handle Them Timely According to Regulations.

The National Healthcare Security Administration (NHSA) stated that the next step would be to follow the requirements of the "Three-Year Action Plan for DRG/DIP Payment System Reform" to improve the management and adjustment mechanisms of core elements, establish sound performance management and operation monitoring mechanisms, form a multi-party evaluation and dispute resolution mechanism, and set up a coordinated promotion mechanism for related reforms. The focus will be on three core elements: disease groups (diagnoses), weights (scores), and coefficients, making the grouping more aligned with clinical needs and local realities, ensuring that weights (scores) better reflect the labor value of medical staff, and using coefficient management to promote the decentralization of medical services, significantly improving the performance of medical service resources and the use of medical insurance funds.

●GSK’s Mepolizumab Injection Approved for New Indication in China

On January 10, GSK announced that the National Medical Products Administration (NMPA) of China had recently approved Mepolizumab Injection for the maintenance treatment of severe eosinophilic asthma (SEA) in adults and adolescents aged 12 years and above. This brand is China's first targeted human anti-interleukin-5 (IL-5) monoclonal antibody biologic for this indication.

In 2021, Mepolizumab Injection was approved in China for the treatment of adult patients with Eosinophilic Granulomatosis with Polyangiitis (EGPA), and was included in the National Medical Insurance Drug List in January 2023. This time, China has approved the expansion of its therapeutic scope for maintenance treatment of Severe Eosinophilic Asthma (SEA) in adults and adolescents aged 12 years and above.

● Eisai's New Insomnia Drug Lemborexant Submitted for Market Approval in China

On January 11, the official website of the Center for Drug Evaluation (CDE) of the China National Medical Products Administration announced that the marketing application for lemborexant tablets, submitted by Eisai under registration category 5.1, has been accepted.

According to publicly available data from Eisai, lemborexant (brand name: Dayvigo) is a dual orexin receptor antagonist. It has already been approved for marketing in the Hong Kong region of China and is used to treat adult insomnia, particularly difficulty falling asleep and/or staying asleep.

● Vice General Manager of Sinopharm investigated for suspected insider trading

On January 10, China National Pharmaceutical Group Co., Ltd. (referred to as: Sinopharm) announced that Tang Lei, the company's vice general manager, has been investigated by the CSRC for suspected insider trading of relevant stocks.

The announcement stated that the investigation concerns Mr. Tang Lei's personal trading of other companies' stocks and does not involve the trading of shares in this company. During the investigation period, Mr. Tang Lei will actively cooperate with the relevant investigation work. Currently, all production and business activities of this company are proceeding normally and in an orderly manner.

●Chuangjian Medical Initiates IPO Listing Guidance

On January 5, Chuangjian Medical submitted coaching filing application materials to the Jiangsu Regulatory Bureau of the China Securities Regulatory Commission and was accepted on January 8. Recently, the official website of the China Securities Regulatory Commission disclosed Chuangjian Medical's listing coaching filing report.

Founded in 2015, Chuangjian Medical is a synthetic biology company focused on the research, production, and sales of functional proteins and novel biomaterials. Renowned international investors such as LVMH and Shiseido have participated in Chuangjian Medical's previous financing rounds.

● Shares of Darrentang's Controlling Shareholder Frozen

On January 10, TCM leader Da Ren Tang plummeted. The day before, Da Ren Tang announced that 70 million shares of the company held by Tianjin Pharmaceutical Group had been frozen, accounting for 21.14% of its total holding and 9.09% of the company's total share capital. The freeze period is from January 8, 2024 to July 7, 2024.

Most of the company's shares were frozen due to debts and legal disputes. The applicant for the freeze was the Shanghai Municipal Supervisory Commission. The reason for the freeze was "investigative needs."

The controlling shareholder of Daren Tang is Tianjin Pharmaceutical Group. However, after the 2020 state-owned enterprise mixed reform, Tianjin Pharmaceutical Group is controlled by Jin-Shen-Zhu Bio-Medical Technology Co., Ltd., with a stake of 67%. The largest shareholder of Jin-Shen-Zhu Bio-Medical is Shanghai Liuli Guang Pharmaceutical Development Co., Ltd., holding a 35% stake. Shanghai Liuli Guang Pharmaceutical is wholly state-owned, and behind it is Shanghai Shangshi Group.

●China CDC: Last Month, China Reported 88 New Severe COVID-19 Cases and 11 Deaths

On January 10, the official website of the Chinese Center for Disease Control and Prevention released the status of the novel coronavirus infection outbreak in China.

From December 1 to December 31, 2023, China's 31 provinces (autonomous regions, municipalities) and the Xinjiang Production and Construction Corps reported 88 new severe cases and 11 deaths (including 2 deaths from respiratory failure caused by SARS-CoV-2 infection and 9 deaths from underlying diseases combined with SARS-CoV-2 infection).

From December 1 to December 31, 2023, the number of outpatient visits in fever clinics (consultation rooms) across China's 31 provinces (autonomous regions, municipalities) and the Xinjiang Production and Construction Corps fluctuated between 230,000 and 360,000. After reaching 348,000 on December 5, the figure began to decline, dropping to a recent low of 230,000 on December 16 before starting to increase again. It reached the month’s highest level of 360,000 on December 28, then slightly decreased, falling to 315,000 by December 31.

From December 1 to December 31, 2023, a total of 3,779 effective genomic sequences of the novel coronavirus from local cases were reported by 31 provinces (autonomous regions, municipalities) and the Xinjiang Production and Construction Corps in China. All cases were identified as the Omicron variant, covering 72 evolutionary branches. The predominant strains were from the XBB series, with the top three being XBB.1.9 and its sub-branches, XBB.1.16 and its sub-branches, and XBB.1.22 and its sub-branches.

According to the sampling date, the proportion of XBB and its sub-branches remains consistently high, while the proportion of JN.1 shows an increasing trend.