ArticleFrontiers in public health2026
Cost distribution and Monte Carlo simulation of financial risk under DRG-based prospective payment for laparoscopic cholecystectomy in patients with gallbladder polyps: a single-center retrospective study.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Under China's Diagnosis-Related Group (DRG) prospective payment system, hospitals bear the financial risk of costs that exceed the fixed reimbursement standard, making case-level cost distribution and the probability of loss critical to departmental sustainability for high-volume, low-complexity procedures such as laparoscopic cholecystectomy. Objective: However, the probability distribution of hospitalization costs and the quantitative financial risk faced by a single institution operating under a fixed DRG payment standard for the group HS10B (laparoscopic cholecystectomy without common bile duct exploration) remain unclear. Methods: This retrospective single-center study included 475 consecutive patients who underwent laparoscopic cholecystectomy (surgery code 51.2300) for gallbladder polyps (DRG group HS10B) over a five-year period (2020-2024; annual case volume ranged from 50 to 136). Total hospitalization cost, medication cost, and material cost were extracted; other cost was derived as total cost minus medication cost minus material cost. Distributional properties were characterized using Kolmogorov-Smirnov normality testing and comparative fitting of normal, log-normal, and Gamma distributions (Akaike information criterion [AIC] and goodness-of-fit testing). Monte Carlo simulation (20,000 iterations), combining parametric resampling from the fitted Gamma distribution and non-parametric bootstrap resampling of the observed cohort, was used to estimate the probability distribution of case-level and aggregate financial margin relative to the local DRG reimbursement standard of ¥12,592. Results: Mean total hospitalization cost was ¥10,293.17 (SD 1,442.22; median ¥10,263.40, IQR ¥9,258.10-11,174.65), which was right-skewed (skewness 0.54) and best represented by a Gamma distribution (Kolmogorov-Smirnov Conclusion: Inpatient cost for HS10B laparoscopic cholecystectomy follows a right-skewed distribution adequately described by a Gamma model; in this single-center cohort, case-specific cost volatility at the individual level was accompanied by a positive aggregate margin at the departmental level, consistent with a risk-pooling effect at this case volume. Hospital administrators should transition from conventional mean-centric accounting toward distribution-aware financial surveillance to better anticipate tail risk under prospective payment systems.
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