Research report: Reconfiguring clinical pharmacists’ roles under China’s DRG payment system: perspectives from clinical pharmacists and physicians in multidisciplinary teams

Clinical pharmacists in two tertiary Grade A hospitals in Nanjing are taking on broader roles in medication selection, expenditure analysis and clinical-pathway design as China’s Diagnosis-Related Group (DRG) payment reform changes the environment in which hospitals make treatment decisions. A qualitative study involving 11 clinical pharmacists and 10 physicians found that both groups valued pharmacists’ medication-safety expertise, but differed over their responsibility for healthcare costs. Some pharmacists described themselves as cost-management contributors who could identify high-expenditure cases and design standardized medication pathways; many physicians continued to see them mainly as advisers on rational prescribing.

The study, based on face-to-face interviews conducted from October 2023 to June 2024, reports perceptions and reported practices rather than measured savings, patient outcomes or changes in hospital finances. DRG is a healthcare payment mechanism that has been widely adopted in different countries to encourage cost control and efficiency. By the end of 2024, China had implemented DRG across all national pooling areas, and from 2025 local authorities advanced a version known as DRG 2.0.

The study notes that the reform altered public hospitals’ revenue and expenditure structures, reducing the relative share associated with pharmaceuticals and medical consumables while increasing the share associated with medical services and personnel. Hospitals consequently placed greater emphasis on healthcare quality, resource-use efficiency and the value of medical services. For clinical pharmacists, this did not replace familiar duties involving medication review and pharmaceutical care; instead, it added expectations that recommendations should consider reimbursement conditions, medicine prices, cost-effectiveness and resource use.

Both professional groups agreed that clinical pharmacists had become established members of multidisciplinary teams, or MDTs. Their work included ward rounds, consultations, prescription review, medication reconciliation, therapeutic drug monitoring and the development of individualized medication plans. Physicians recognized pharmacists’ ability to identify duplicate therapies, contraindications, prescribing errors and omissions, as well as their contribution to patient counselling and the dissemination of pharmaceutical knowledge.

One physician recalled that a pharmacist noticed that trihexyphenidyl had been omitted when another clinician prescribed injectable haloperidol, despite the team’s usual practice of combining the medicines to prevent extrapyramidal symptoms. These accounts illustrate medication-safety activities recognized by the interviewees, but they are not estimates of adverse-event reduction. The research did not compare patient outcomes in teams with and without pharmacist involvement.

The clearest disagreement concerned the economic role expected of pharmacists under DRG. Some pharmacists said they analyzed cases whose expenditures exceeded the expected payment, proposed medication substitutions or de-escalation, reconciled medicines and helped develop medication pathways for priority disease groups. They also considered centrally procured medicines, medicines included in national price negotiations and originator products when evaluating treatment options, while continuing to monitor effectiveness and adverse effects.

Several described reviewing medicines across hospital wards and participating in the implementation of clinical pathways. A few also described departmental innovation projects that combined medication reconciliation or substitution with evaluation of patient outcomes and DRG balances. However, the interviews did not provide verified financial totals, controlled comparisons or systematic estimates of savings, so the findings cannot establish the magnitude of any economic effect.

Not every pharmacist had incorporated the new payment environment into daily practice. Some reported that DRG had made little difference to their work, illustrating that changes in professional responsibilities were uneven even within the pharmacy workforce. Physicians were also less likely to recognize the broader activities described by pharmacists.

Many regarded cost control as primarily their own responsibility and described pharmacists as reviewers of indications, contraindications and rational medication use. Some saw a useful economic contribution in a recommendation for a lower-cost alternative, but did not treat expenditure analysis, pathway design or resource allocation as formal pharmacist functions. One described the pharmacist’s contribution chiefly as suggesting a medicine with better cost-effectiveness.

This difference in perception did not necessarily mean that physicians rejected pharmacist expertise; rather, it showed that the teams had not developed a shared description of who should lead cost-related work and how such work should be integrated into clinical decisions. Institutional arrangements constrained pharmacists’ ability to translate their expertise into action. They described having responsibility for cost-related review while retaining limited authority over final treatment decisions, which remained with physicians and clinical departments.

Timely access to DRG grouping and expenditure data was also limited, and poorly integrated information systems forced some pharmacists to move between separate hospital platforms to obtain relevant information. The workload associated with ward rounds, prescription checks, patient education and therapeutic drug monitoring could exceed available staffing, with some tasks carried over to the following day. Pharmacists also described the absence of reimbursement for some pharmaceutical services, meaning expanded responsibilities could remain unpaid.

Patients’ limited familiarity with the clinical pharmacist role added another obstacle, because many continued to direct medication questions primarily to physicians rather than seeking individualized guidance from pharmacists. Physicians were generally positive about collaboration but emphasized practical limits. They often sought pharmacist input for complex, difficult or potentially risky cases while managing routine treatment decisions independently.

Some considered recently employed pharmacists to have limited clinical experience, and the researchers recorded occasional differences in emphasis: a pharmacist might stress adherence to antibiotic guidelines, whereas a physician might focus on the extent of a particular operation and the perceived need for stronger prophylaxis. These observations do not show that pharmacist recommendations were harmful or that either perspective was uniformly correct. Instead, they illustrate differences in clinical reasoning that may arise when multidisciplinary members do not share the same level of specialization.

Physicians proposed that pharmacists develop expertise in selected clinical areas, provide regular training on new medicines and the latest pharmacotherapy evidence, improve communication with patients and clinical teams, and help communicate clinical medication needs to pharmacy and therapeutics committees. Pharmacists emphasized a different set of changes. They called for clearer legal and professional boundaries through a national Pharmacists Law, reimbursement for pharmaceutical care, greater decision-making authority and better digital infrastructure.

Proposed tools included real-time alerts when a case approached a DRG expenditure threshold, integration of pharmacy workstations with other hospital information systems, and direct access to case groupings, departmental costs and medication-use data. Pharmacists also sought more influential roles in medication management and quality governance. Physicians additionally expected them to warn departments about possible budget overruns, support reimbursement appeals and handle medication-related compliance documentation.

The two groups therefore shared a broad desire for closer collaboration, but differed over whether pharmacists should primarily advise clinicians or participate more directly in institutional cost management. Their proposed measures also revealed a shared practical problem: expanded responsibilities require timely data, adequate staffing, professional authority, digital support and resources that permit sustained service rather than unfunded additions to already heavy workloads. The study, reported in Frontiers in Public Health, offers a detailed account of role change in a health system where DRG payment reform, centralized medicine procurement and physician-led decision-making operate together.

It suggests that DRG has encouraged some pharmacists to combine clinical expertise with pharmacoeconomic reasoning without replacing their core role in medication safety and appropriate use. It also shows why a narrow assessment of cost savings may miss much of the work that participants described. Pharmacists’ activities involving therapy evaluation, patient safety, pathway development and expenditure analysis were often retrospective, distributed across cases or embedded in communication, making their contribution less visible than a single prescription substitution.

The interviews nevertheless remain qualitative accounts from a small group rather than measurements of efficiency. The sample was drawn from only two tertiary Grade A hospitals in one city, participants may have been influenced by social desirability, and nurses, hospital administrators and other MDT members were not interviewed. The results therefore describe how these 21 participants understood collaboration and role ambiguity; they do not establish how representative the experience is nationwide or whether expanded pharmacist involvement improves clinical outcomes or reduces costs.

Subject of Research: Clinical pharmacists’ changing roles in multidisciplinary teams under China’s DRG payment reform

Article Title: Reconfiguring clinical pharmacists’ roles under China’s DRG payment system: perspectives from clinical pharmacists and physicians in multidisciplinary teams

Article References: Fu, J., Gao, X., Sun, Q., Xi, X., & Wang, J. (2026). Reconfiguring clinical pharmacists’ roles under China’s DRG payment system: perspectives from clinical pharmacists and physicians in multidisciplinary teams. Frontiers in Public Health, 14, Article 1930532. https://doi.org/10.3389/fpubh.2026.1930532

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1930532

Keywords: clinical pharmacists, DRG payment reform, multidisciplinary teams, healthcare cost management, pharmaceutical care, medication safety, qualitative research, hospital pharmacy, China, Reconfiguring, clinical, pharmacists