How Cost-Effective is “Seeing a Doctor During the Day and Going Home at Night” for Tumor Treatment?
Hello everyone, I’m your financial journalist. Today, we’re going to talk about a topic that affects many families: tumor treatment.
In the past, being diagnosed with a tumor often meant a long stay in the hospital, requiring someone from home to care for the patient, which put a lot of financial strain on the family and took a toll on both the patient’s physical and mental health. Now, a new model called daytime diagnosis and treatment is emerging—basically, patients receive injections and undergo tests during the day and then go home to sleep at night. This sounds like a great idea, as it frees up hospital beds and reduces the burden on patients.
However, the reality is a bit complicated: although everyone agrees that this model is good, there are many obstacles to its implementation. Hospitals lack the motivation, doctors are not enthusiastic, patients are worried about the extra cost, and health insurance companies are concerned about potential losses. How can we untangle this mess?
During the 2026 China International Fair for Trade in Services, Professor Ding Jinxī, the vice president of China Pharmaceutical University, proposed a solution. His main point is clear: to motivate both patients and hospitals, we need to work together through three mechanisms: health insurance, compensation, and evaluation systems.
Let me break down this news into five parts to explain the logic and the underlying interests involved.
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What is “Daytime Diagnosis and Treatment,” and Why is it so Popular?
First, let’s understand what daytime diagnosis and treatment really is. It’s not just a regular outpatient visit (where you leave immediately after the consultation) nor a traditional hospital stay (staying in the hospital 24 hours a day). It’s specifically designed for tumor patients who need short-term treatment, observation, or special tests. For example, some new anti-tumor drugs used to require intravenous infusions and a full day in the hospital; now, with new formulations (such as subcutaneous injections), the treatment is simpler, and patients can come to the hospital during the day and go home to rest at night.
Why is it so popular? Because it’s cost-effective and efficient. Professor Ding Jinxī gave a real example: A breast cancer department at a top-tier hospital in Suzhou switched from traditional intravenous treatments to the new subcutaneous formulations. As a result, each patient saved more than 46,300 yuan in medication costs per year!
This is good for everyone:
- For patients: Less money spent, less suffering, and no need to wait in the hospital for a bed.
- For health insurance: Reduced fund expenditures, making better use of the money.
- For hospitals: Faster bed turnover, allowing them to accommodate more patients.
Sounds perfect, right? But the problem is that the interests of all parties don’t automatically align behind this “perfection.”
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Why are Hospitals and Doctors Not Enthusiastic? Because It’s Not Profitable
If daytime diagnosis and treatment is so beneficial, why don’t hospitals push for it? Why do doctors still prefer hospital stays?
The main reason is the current evaluation and compensation systems, which make it unprofitable for hospitals and doctors.
1. Hospitals’ Concern about CMI (Case Mix Index): Public hospitals are evaluated based on the CMI value, which reflects the complexity of the cases they treat. Difficult and serious cases have a higher CMI value, while minor or simple cases have a lower one. If hospitals dedicate many beds to daytime treatments, they may lower their overall CMI value, affecting their performance evaluations. It’s like a Michelin-starred restaurant that only serves pancakes—although it might generate a lot of business, its reputation and rating would decline.
2. Doctors’ Compensation: The traditional compensation system is based on the number of inpatients. Daytime treatments are shorter and less labor-intensive, so doctors might not earn as much as they would with long-stay patients. The current performance monitoring systems hardly take into account daytime treatments.
3. Blurred Responsibilities: Daytime treatments involve more than just the treatment; doctors also need to ensure patients can tolerate the treatment and follow up after discharge. If something goes wrong at home, who is responsible? This uncertainty makes doctors hesitant to adopt this model.
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How to Motivate Hospitals and Doctors? With Money, Power, and Clear Rules
Professor Ding Jinxī’s solution focuses on reallocating benefits and innovating mechanisms. Here are three practical suggestions:
1. Clear Compensation: Performance should be linked to the original department. In previous trials, departments operated their own daytime centers, which led to resource inefficiencies. The future trend is to establish unified daytime centers, but this raises the question of how to allocate revenue. The solution is to keep the performance from daytime treatments with the original department, so they don’t lose income and still have less management work.
2. Smart Evaluation: Use the CMI value as a common metric for both doctors and nurses. If doctors treat too many simple cases, their performance will be penalized, encouraging them to refer more complex cases to daytime treatments.
3. Clear Rewards and Penalties: Implement a system where doctors receive more rewards for efficient treatments and penalties for unnecessary hospital stays. For example, a hospital in Henan offered triple rewards for standardized daytime surgeries completed within 24 hours and reduced the chief surgeon’s fee for non-standard daytime procedures. This direct incentive strategy has proven effective.
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Why Don’t Patients Choose Daytime Treatments? Because of Differences in Insurance Reimbursement
Besides hospitals and doctors, patients are the ultimate decision-makers. If doctors offer two options—hospital stay or daytime treatment—with the same efficacy, which one will patients choose?
The answer is simple: they’ll choose the option with the higher reimbursement rate. Currently, there are two main ways for health insurance to reimburse daytime treatments in China:
- As an outpatient visit: Lower deductible, but lower reimbursement rate (e.g., 45%-55%).
- As a hospital stay: Higher deductible, but higher reimbursement rate (e.g., 75%-80%).
Professor Ding Jinxī cited examples from two northern cities:
- Tianjin: Tumor day treatments are reimbursed as outpatient chronic diseases, with a 45%-55% rate.
- Shenyang: Reimbursed at the hospital rate, with a 75%-80% rate.
The result is clear: Patients in Tianjin pay more out of their own pockets. If the reimbursement for daytime treatments is lower, they’ll prefer a longer hospital stay.
This creates a dilemma:
- Hospitals want more patients to use daytime treatments to save money and improve efficiency.
- Patients want hospital stays for higher reimbursement and less financial burden.
- Health insurance wants to control costs.
How to resolve this? Although the cost of medications might be similar for both, beds, nursing, and testing fees are much lower for daytime treatments. For example, in Xiamen, non-medication costs for a standard hospital stay are 409-679 yuan, while for daytime treatments, they are only 80-170 yuan. This means that even with the same reimbursement rate, health insurance spends less overall.
Therefore, not lowering patient reimbursement and controlling health insurance costs are not contradictory goals. By aligning the reimbursement rates, health insurance can save money.
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The Ultimate Solution: Pay by Disease Type to Ensure Equal Reimbursement
The core solution is paying by disease type (DRG/DIP). The health insurance bureau sets a fixed price for each disease. For example, the insurance will pay a fixed amount for a certain type of breast cancer day treatment, regardless of the actual costs. If the hospital saves money through optimized processes (like using daytime treatments), the savings can be kept by the hospital; if it overspends, it has to cover the difference.
Why does this work?
- For health insurance: Expenses are more controllable, and there’s no unlimited reimbursement for individual items.
- For hospitals: There’s an incentive to reduce costs, as the savings belong to them.
- For patients: As long as the reimbursement rate is not lower than that of hospital stays, there’s no reason for them to refuse daytime treatments.
Cities like Xining, Inner Mongolia, Jiangxi, and Anhui are already exploring this approach. For instance, Xining has included 43 types of day surgeries in the DRG/DIP system, with good results.
Professor Ding Jinxī’s final recommendation is to establish a directory of suitable diseases for daytime treatments, focusing on those with clear diagnoses, clear treatment paths, and stable costs. Reimbursement rates should be set to match those of hospital stays, meeting the needs of both patients and health insurance.
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In Summary: A Win-Win Reform for All
Promoting daytime tumor treatments is not just about medical technology; it’s also about restructuring interests. It benefits patients by reducing costs and improving their quality of life, hospitals by increasing bed turnover and optimizing revenue, and health insurance by controlling costs and ensuring sustainability. It also makes doctors’ work more valuable through proper incentives.
The key is collaboration:
- Health insurance needs to change its payment rules to align with hospital reimbursement rates.
- Hospitals need to reform their evaluation systems.
- Policies need to clarify the appropriate use of daytime treatments and standardize management.
Only when these three parties work together can we turn a promising model into a reality that benefits everyone, making cancer treatment more accessible and effective for patients and ensuring that medical resources are used efficiently.
This is the future we’re looking forward to.