ArticleBMC health services research2023
Variations in the impact of the new case-based payment reform on medical costs, length of stay, and quality across different hospitals in China: an interrupted time series analysis.
Article in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
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Who cites it
31 citing papers in PubMed.
- Temporal Associations and Heterogeneity of Diagnosis-Related Group (DRG) Payment Reform with Hospitalization Costs Among Patients with Colorectal Cancer in China.Healthcare (Basel, Switzerland) · 2026Article
- Evaluating the Effect of Diagnosis-Intervention Packet (DIP) Reform in China on Hospitalization Outcomes for Patients with Chronic Obstructive Pulmonary Disease with Special Reference to M City.Healthcare (Basel, Switzerland) · 2026Article
- The epidemic and socioeconomic factors shock: a long-term dynamic analysis of equity in infectious disease healthcare in China.International journal for equity in health · 2026Article
- Behavioral responses of healthcare providers to prospective payment systems: a systematic review using the WHO framework (2000-2024).Health economics review · 2026Review
- Beyond average costs: large-scale evidence on DRG payment reform and the distribution of standardized inpatient spending in China.Health economics review · 2026Article
- Improving Equitable Access to Antenatal Care in China: Challenges and Potential Innovative Approaches.China CDC weekly · 2026Article
- Impact of the Tiered-Network Healthcare Policy (TNHP) on the health resource allocation, patients flow and service efficiencies of Primary Healthcare Institutions (PHCIs) in China: an interrupted time series study.BMC health services research · 2026Article
- The impact of DIP payment reform on hospitalization costs and equity in type 2 diabetes mellitus patients: evidence from a pilot city in Central China.Frontiers in public health · 2026Article
- Risk Governance of Payment Exceptions Under China's DRG/DIP Reform: A Structured Policy-Text Analysis of Special Case Negotiation Rules.Risk management and healthcare policy · 2026Article
- Impact of an innovative case-based payment reform on hospital cost variation: insights from cerebral infarction inpatients in China.International journal for equity in health · 2025Article
- Impact of China's Diagnosis-Intervention Packet Policy on Hospitalization Costs for Patients With Malignant Tumors: A 2019-2022 Interrupted Time Series Analysis.Risk management and healthcare policy · 2025Article
- Impact of DRG policy on the performance of tertiary hospital inpatient services in Chongqing, China: an interrupted time series study, 2020-2023.Frontiers in public health · 2025Article
- Article
- A study of the impact of DIP payment reform on coronary heart disease hospitalization costs and equity.Frontiers in public health · 2025Article
- How DRG Payment Reform Shapes Inpatient Neurological Care in an Underdeveloped Region: Evidence from a Controlled Interrupted Time Series Study in Yunnan, China.Risk management and healthcare policy · 2025Article
- Interrupted time series analysis of the impact of DIP reform on hospitalization costs in different types of hospitals.Frontiers in public health · 2025Article
- DRG payment does not predispose to negative clinical outcomes in general surgery cases: evidence from a tertiary hospital in China.Frontiers in public health · 2025Article
- Evaluation of the effect of DRG payment policy based on interrupted time series modeling: evidence from a tertiary hospital in Anhui Province.Health research policy and systems · 2024Article
- Does an innovative case-based payment scheme promote the hierarchical medical system? A tripartite evolutionary game analysis.International journal for equity in health · 2024Article
- Impact of the Diagnosis-Intervention Packet Payment Reform on Provider Behavior in China: A Controlled Interrupted Time Series Study.International journal of health policy and management · 2024Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundIn 2018, an innovative case-based payment scheme called Diagnosis-Intervention Packet (DIP) was piloted in a large developed city in southern China. This study aimed to investigate the impact of the new payment method on total medical expenditure per case, length of stay (LOS), and in-hospital mortality rate across different hospitals.
methodsWe used the de-identified patient-level discharge data of hospitalized patients from 2016 to 2019 in our study city. The interrupted time series model was used to examine the impact of the DIP payment reform on inflation-adjusted total expenditure per case, LOS, and in-hospital mortality rate across different hospitals, which were stratified into different hospital ownerships (public and private) and hospital levels (tertiary, secondary, and primary).
resultsWe included 2.08 million and 2.98 million discharge cases of insured patients before and after the DIP payment reform, respectively. The DIP payment reform resulted in a significant increase of the monthly trend of adjusted total expenditure per case in public (1.1%, P = 0.000), tertiary (0.6%, P = 0.000), secondary (0.4%, P = 0.047) and primary hospitals (0.9%, P = 0.039). The monthly trend of LOS increased significantly in public (0.022 days, P = 0.041) and primary (0.235 days, P = 0.032) hospitals. The monthly trend of in-hospital mortality rate decreased significantly in private (0.083 percentage points, P = 0.002) and secondary (0.037 percentage points, P = 0.002) hospitals.
conclusionsWe conclude that implementing the DIP payment reform yields inconsistent consequences across different hospitals. DIP reform encouraged public hospitals and high-level hospitals to treat patients with higher illness severities and requiring high treatment intensity, resulting in a significant increase in total expenditure per case. The inconsistencies between public and private hospitals may be attributed to their different baseline levels prior to the reform and their different responses to the incentives created by the reform.
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