Medical Stakeholders’ Views on the Use of Packaged Charging Based on the Diagnosis-Related Group (DRG) in the Proposed Healthcare Reform

The second stage consultation of healthcare reform in Hong Kong was launched in late 2010. One of the key features in the healthcare reform is the use of packaged charging based on Diagnosis-Related Group (DRG) structure, for reimbursement of medical fees in order to enhance cost certainty and transparency in private healthcare services. The objective of the study was to investigate the comments, concerns and suggestions of medical practitioners and private hospitals about medical pricing based on DRG. A survey completed by 1100 medical practitioners, seven focus groups with 42 medical practitioners and six hospital administrators participated was conducted. Generally, the participants believed that DRG was more applicable to straight-forward and one-off treatment procedures. Those working in the private sector and non-Family Medicine specialists were more concerned about the desirability and feasibility of DRG, and the potential of control of pricing in private market. The practice of DRG-based pricing method in certain specialties and cases which required multiple examinations and procedures for diagnosis were discussed. Concerns about doctors’ selection of cases, upcoding and gaming on the charging system, as well as the high administration cost were also raised.