China Ties Reimbursement for Laboratory Tests to Data Storage and Upload
China Ties Reimbursement for Laboratory Tests to Data Storage and Upload
On August 14, China’s National Healthcare Security Administration issued trial pricing guidelines for laboratory services. The document consolidates previous regional billing items into 662 core rates, 114 surcharges, and 7 extensions. Provinces must set a unified baseline price level, while municipalities authorized to regulate rates must set their actual prices around that level.
Previously, most regions reimbursed the same test at different rates depending on the method used. The new guidelines establish a single price for each measured parameter, regardless of the technology. For example, blood glucose testing now has one rate instead of separate rates for different measurement methods.
Reimbursement now also depends on data storage. In an official explanation, the agency introduced a rule requiring clinics to store data on how a test was performed and its result, then submit these data to the system. If a laboratory does not store and upload this information, insurance reimbursement for each parameter is reduced by 10%, up to a maximum of 5 yuan. When one test measures several parameters, the total deduction is also capped at 5 yuan.
The regulator introduced this requirement so that test results can be recognized across clinics and regions. A result consisting of a single number is not enough for another physician to use it. The record must also include the reference interval, which is the expected range against which the measurement was compared.
For 17 types of tests, the guidelines also regulate this part of the record. If the uploaded reference interval differs from the industry standard, reimbursement for the parameter is reduced by 5%, up to a maximum of 0.5 yuan. The only exception applies to population groups for whom the standard range is objectively unsuitable, such as people living at high altitude.
The test’s digital record has therefore become a required part of the reimbursable medical service. The government eliminated differences in rates between technologies and directly tied full reimbursement to the submission of data that other physicians can reuse.