Detecting Undifferentiation of Tertiary and County Hospitals in China in Adoption of DRG Instrument

Abstract

(1) Background: Undifferentiated function for medical institutes in different levels had been a barrier to China’s healthcare reform. Thus, this study aimed to detect medical services that were capable offered both in tertiary and county hospitals in China and discuss the process of detection. (2) Method: Data of 2 tertiary hospitals that were city level and 12 county-level hospitals from one city in China were collected and grouped into diagnosis-related groups (DRGs). A strategy with four steps was devised by considering the aspects of service volume, in-hospital mortality rate, in-hospital adverse events rate, and inpatient cost. Additionally, a comparison of each indicator was made between city- versus county-level hospitals. (3) Results: There were no differences in service quality between the two levels of hospitals while county hospitals had lower average inpatient costs in 129 DRGs that covered 39.5% of all cases. About CNY 0.26 billion would be saved if certain cases were paid at county-level prices. (4) Conclusion: The study proposed a strategy with four steps that could help in locating the range of diseases in which patients’ admission suffered from the problem of undifferentiation between hospitals’ functions to reduce the irrational growth of healthcare expenditure.

Differences in inpatient performance of public general hospitals following implementation of a points-counting payment based on diagnosis-related group: a robust multiple interrupted time series study in Wenzhou, China

“…Due to Chinese citizens being at liberty to choose healthcare services at any institution, tertiary institutions with higher levels of comprehensive medical strength can attract more patients under the siphon effect 42 43. With service accessibility improving, patients would rather visit tertiary hospitals, even though most of their illnesses are not severe 44 45. As a result, it improved the number of low-related weight cases to be treated at tertiary institutions, which constrained the improvement in CMI and also affected the hierarchic healthcare treatment system performance for a long time.…”

“… 42 43 With service accessibility improving, patients would rather visit tertiary hospitals, even though most of their illnesses are not severe. 44 45 As a result, it improved the number of low-related weight cases to be treated at tertiary institutions, which constrained the improvement in CMI and also affected the hierarchic healthcare treatment system performance for a long time. Significantly, under the influence of the DRG payment rules, tertiary institutions tended to treat more serious diseases (that possess high relative weights) and were willing to transfer the more common or easy-to-treat cases to lower-grade institutions.…”

Redefining Tertiary Care in India

“…In the majority of hospitals in other countries such as the United Kingdom and France are public facilities [6].…”