National Healthcare Security Administration Shifts to Value-Based Pricing with Six New Service Guidelines
On September 25, the National Healthcare Security Administration held the fourth live-streamed interpretation session of the Guidelines for Project Initiation of Medical Service Prices, themed “Better Life,” which covered six categories: gynecology, obstetrics, anesthesiology, rehabilitation, the integumentary system, and cosmetic plastic surgery.
VCBeat learned at the live broadcast that, to date, the National Healthcare Security Administration has issued 33 batches of project establishment guidelines, integrating and establishing a total of 1,640 main items, 599 additional charge items, and 156 expanded items.
In developing the project establishment guidelines for gynecology, obstetrics, and anesthesiology, the National Healthcare Security Administration adhered to an output-oriented approach, pursued moderate integration, and standardized definitions of anatomical sites and service content. Meanwhile, policy support was provided to promote childbirth and meet patients’ individualized needs. The 271 existing items, previously established separately by anatomical site, equipment, or procedural step, were consolidated based on the principle of service outputs by “merging similar items.” These have been integrated into 124 main items, 30 additional-charge items, and 7 extended items, basically covering all diagnostic and therapeutic services involved in these three sets of guidelines.
Going forward, the National Healthcare Security Administration will accelerate the development of project establishment guidelines for pharmaceutical services, laboratory testing, and auxiliary procedures, guiding local healthcare security departments to complete overall integration and implementation by 2026. The National Healthcare Security Administration will continue to monitor new technologies and products, providing guidance to provincial healthcare security bureaus on the addition, revision, and harmonization of items in accordance with established procedures.
“The transition from old projects to new ones reflects a deeper shift in project approval logic, moving from approval based on operational details to approval based on service outputs. New projects place greater emphasis on evaluating the value of medical technologies from the perspective of patient benefits, further embodying the fundamental principle that ‘value determines price,’” pointed out Jiang Bingzhen, Director of the Medical Price Division under the Price and Procurement Department of the National Healthcare Security Administration.
According to the National Healthcare Security Administration, the project establishment guidelines standardize old items with similar service outputs and comparable price levels into new items by “consolidating like items,” thereby gradually addressing issues such as inconsistent pricing items across regions, incomparable price levels, and unclear billing boundaries.
According to relevant personnel from the healthcare security administrations of four leading provinces—Henan, Guangdong, Sichuan, and Gansu—the original 54 rehabilitation-related service items have been standardized and consolidated into 17. Rehabilitation training services are now priced per “half-hour,” with a policy established for additional charges for “every additional 10 minutes.” In Guangdong, the original 208 price items for the musculoskeletal system have been consolidated into 53, while the original cosmetic and plastic surgery price items have been standardized into 101. In Sichuan, gynecological services have been consolidated into 85 main items and 13 extended-code items, with the original 190 items discontinued; obstetric services have been consolidated into 30 main items and 15 extended-code items, with the original 61 items discontinued.
During the implementation of the project establishment guidelines for anesthetic services,Gansu Province has mapped all 40 original anesthesia-related items to the 10 items specified in the project establishment guidelines, effectively preventing duplicate charges and fragmentation of service items.
After the implementation of the project approval guidelines, the most immediate feeling among anesthesiologists was that “we can finally devote our full attention to patients.”
Chang Peng, Vice President of the Second Hospital of Lanzhou University, offered a vivid analogy: “In the past, doctors had to keep two forms in mind—the anesthesia record and the billing sheet. Now, regardless of whether it is general anesthesia, neuraxial anesthesia, or nerve block, once the anesthesia method is selected, the anesthesia fee is automatically generated, eliminating the need for doctors to check items one by one.”
Chang Peng stated that, to align with the new guidelines’ requirement of extending the anesthesia billing cycle to cover the recovery phase, the hospital has completed data integration between its Hospital Information System (HIS) and the Surgical Anesthesia System. The HIS can now automatically retrieve and calculate the duration of anesthesia in the operating room and the time spent in the post-anesthesia care unit (PACU), generating the total anesthesia duration. This enables continuous timing throughout the entire anesthesia cycle, thereby eliminating duplicate timing and billing while reducing the time consumed by manual operations.
Notably, in fields such as gynecology, obstetrics, and anesthesiology, guidelines appropriately refine the granularity of pricing items and define complex scenarios, assigning higher prices to these complex cases.
Complex cases and procedures characterized by high technical labor value and significant risk are listed as separate items. For instance, “vaginal delivery” is divided into two distinct items: “Vaginal Delivery (Routine)” and “Vaginal Delivery (Complex).” The project establishment guidelines specify that complex scenarios include conditions such as scarred uterus, macrosomia, fetal breech presentation, and shoulder dystocia. Additionally, situations requiring instrumental assistance or manual removal of the placenta during delivery are also classified as complex. Medical institutions may charge fees based on actual circumstances.
Meanwhile, the guidelines have established specific additional fee items for anesthesia administered to pediatric, elderly, and critically ill patients. In light of the high anesthetic risks, technical complexity, and scarcity of specialized personnel associated with these patient groups, this measure provides institutionalized compensation for the additional risk costs borne by anesthesia medical staff and their investment in high-difficulty technical expertise.
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Xiong Wenying, Director of the Price and Procurement Division of the Sichuan Provincial Healthcare Security Administration, stated thatThe Project Establishment Guidelines for Gynecology and Obstetrics Have Separately Established Items for “Labor Analgesia,” “Doula-Assisted Delivery,” and “Family-Accompanied Childbirth”, so that “Mother’s Day of Suffering” is no longer synonymous with “Day of Pain.”
Furthermore, the project approval guideline system has established pricing items such as “Ovarian Tissue Cryopreservation Fee,” “Ovarian Tissue Storage Fee,” “Ovarian Tissue Thawing Fee,” and “Ovarian Tissue Transplantation Fee” to meet personalized fertility needs. Meanwhile, personalized service items, including family companionship and manual pelvic floor therapy, have been added.
Another widely watched topic is the pricing of cosmetic and plastic surgery procedures.
Jiang Bingzhen introduced that the market size of China’s cosmetic surgery industry has reached approximately RMB 300 billion, with hundreds of thousands of people traveling abroad for cosmetic procedures each year. According to statistics from relevant South Korean authorities, 261,000 Chinese citizens traveled to South Korea for cosmetic surgery in 2024. This indicates that domestic demand for medical aesthetics remains inadequately met, suggesting broad market prospects and highlighting the necessity to standardize pricing items for cosmetic surgery services.
“The Project Initiation Guidelines do not alter the market-regulated pricing mechanism for cosmetic and plastic surgery; such procedures remain outside the scope of basic medical services, with pricing determined autonomously by medical institutions.”The National Healthcare Security Administration emphasized that “the primary rationale for standardizing pricing items for cosmetic and plastic surgery is to align with the public’s aspiration for a better life and pursuit of enhanced appearance. By regulating pricing items, we aim to promote the supply of high-quality cosmetic and plastic surgery services in China, guide public medical institutions in setting independent and reasonable prices, and lead non-public medical institutions toward standardized service delivery and charging practices.”
Rehabilitation guidelines have adjusted the pricing unit for rehabilitation training services to be based on duration, while also adding new items such as daily living skills rehabilitation training, vocational skills rehabilitation training, and organ function rehabilitation training, thereby comprehensively addressing clinical rehabilitation needs across multiple systems, including neurological, musculoskeletal, cardiopulmonary, and pelvic floor.
Feng Xiaodong, President of Henan Provincial Hospital of Traditional Chinese Medicine, stated that compared with previous projects,A notable highlight of the new guidelines is the inclusion of “AI-assisted” as an “extended item” under the main category of rehabilitation training.
“With the application of artificial intelligence technologies such as rehabilitation robots and brain-computer interfaces, healthcare providers previously had to apply for new price items before charging fees, a process involving numerous approval procedures and long cycles. The current project initiation guidelines now classify AI-assisted therapy as an extended item under rehabilitation training, accelerating the clinical translation of innovative technologies and equipment and effectively promoting technology-enabled rehabilitation treatment,” pointed out Feng Xiaodong.