Impacts of a New Episode-Based Payment Scheme on Volume, Expenditures, and Efficiency in Public Hospitals: A Quasi-Experimental Interrupted Time-Series Study in Jinhua, China

Zhang, Tao; Lu, Beiyin; Yan, Zhongheng; Huang, Xiaojun; Lu, Wei

doi:10.2147/rmhp.s376516

Cited by 7 publications

(8 citation statements)

References 25 publications

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“…Previous study showed patient and cost-shifting from inpatient to outpatient setting with the adoption of DRGs system, which resulted in a rapid growth of outpatient expenditures. 6,20 Encouragingly, this innovative payment scheme corrected the aforementioned unwanted responses. The unit of reimbursement under APGs system, as a case-based payment method, is similar to that under the DRGs.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the cost-shifting from the inpatient to outpatient setting was found. 6 For a long time, FFS for outpatient care has been adopted in China and no financial incentives have been provided to control utilisation of services in outpatient setting. 6 Physicians had strong incentives to increase the volume of procedures and drug prescriptions.…”

Section: Introductionmentioning

confidence: 99%

“… 6 For a long time, FFS for outpatient care has been adopted in China and no financial incentives have been provided to control utilisation of services in outpatient setting. 6 Physicians had strong incentives to increase the volume of procedures and drug prescriptions. Data showed that outpatient expenditures per visit increased faster than that in the inpatient setting from 233.9 yuan in 2015 to 324.4 yuan in 2020 in China.…”

Section: Introductionmentioning

confidence: 99%

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Impacts of Outpatient Payment Reforms on Volume and Expenditures in Public Hospitals: Evidence from a Quasi-Experimental Analysis in Zhejiang, China

Zhang¹,

Lu²,

Yang³

et al. 2023

RMHP

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Purpose China developed an innovative episode-based payment scheme for outpatient care, namely “Ambulatory Patient Groups (APGs) + capitation” payment, to constrain inflation in outpatient expenditures. This study aimed to assess the effects of this payment method on volume and expenditures in Chinese public hospitals. Methods A quasi-experimental study was conducted with 7 municipal and 12 county hospitals from Jinhua as the intervention group and 15 municipal and 24 county hospitals from three neighbouring cities as the control group. The payment reform was introduced to municipal and county hospitals in the intervention group in January 2020 and January 2021, respectively. Monthly data on volumes and outpatient expenditures were collected from each hospital from January 2019 to December 2021. Controlled interrupted time-series analyses were performed to determine the effects of the funding reforms. Results Outpatient visits in municipal hospitals decreased by 1417.54 (p=0.048) per month on average compared with control ones after the reform was implemented, whilst that in county hospitals increased by 1058.04 (p=0.041) per month on average. The trend of drug expenditures ( β 7 =−1.41, p=0.019) in municipal hospitals dropped, which was accompanied by an immediate reduction in consumable expenditures ( β 6 =−6.89, p=0.044). The funding reform also led to the significant declines in drug ( β 6 =−10.96, p=0.009) and consumable ( β 6 =−4.78, p=0.041) expenditures in county hospitals. Municipal hospitals experienced the drop in the trend of total outpatient expenditures ( β 7 =−3.99, p=0.018) over the same period. Conclusion The strength of the “AGPs + capitation” payment for outpatient care lies in its ability to control the excessive growth of medical expenses through correcting inappropriate incentives. However, minimising potential cost-shifting and risk-shifting to uninsured service items should be given attention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impacts of Outpatient Payment Reforms on Volume and Expenditures in Public Hospitals: Evidence from a Quasi-Experimental Analysis in Zhejiang, China

Zhang¹,

Lu²,

Yang³

et al. 2023

RMHP

Self Cite

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“…At the same time, the operation efficiency of the hospital had been improved, that was, the hospital had better control of the treatment time and drug use of patients, and the quality and efficiency of medical services had been improved. 21 Murphy et al found shorter operative time, less blood loss, and shorter hospital stays in physician-initiated behaviors. However, in the hospital-initiated behavior, the operation time was longer, the blood loss was greater, and the length of hospital stay was longer.…”

Section: Resultsmentioning

confidence: 99%

A Bibliometric Analysis of Diagnosis Related Groups from 2013 to 2022

Lang¹,

Guo²,

Li³

et al. 2023

RMHP

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Purpose As an important management method of the global healthcare system, diagnosis related groups (DRGs) classify patients into different cost groups and pay more attention to the equitable distribution of medical resources and the quality of medical services. At present, most countries have used DRGs to help medical institutions and doctors to treat patients more accurately, avoid the waste of medical resources, and improve treatment efficiency. Methods The Web of Science database was searched to collect all relevant literature on DRGs from 2013 to 2022. The literature information was imported into CiteSpace, Vosviewer, and Histcite for data analysis and visualization of the results. Analyze the cooperative relationship among the countries, institutions, journals, and authors. The usage trend of keywords; Highlight the content of the cited articles. Results The number of articles published in this decade was stable, and the number of citations in 2014 was the highest. The United States and Germany, as the first countries to use the DRGs system, are ahead of other countries in terms of the number and quality of articles. We have carried out content research on the articles with high citations, and summarized the application range of DRGs; classification method; advantages and disadvantages of the application. In general, the development trend of DRGs in foreign countries is to continuously optimize the classification method, expand the scope of application, and improve the application effect. These provide support and reference for the improvement of medical services and the perfection of the medical insurance system. Conclusion The application of DRGs can improve the quality and efficiency of medical services, and reduce the waste of medical expenses. It can also promote the rational allocation of medical resources and the equity of medical services. In the future, DRGs will pay more attention to the personalized diagnosis and treatment and fine management of patients, and the sharing and standardization of medical data, to promote the development of medical informatization.

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“…The Chinese government is making significant efforts to advance DIP reforms in an attempt to influence the behavior of healthcare providers positively [27,28]. While previous studies have examined the impact of DIP payment reform on per-admission spending, out-of-pocket spending, length of stay, and quality of healthcare in Chinese hospitals, there has been a notable absence of discussion regarding whether the case-based payment is conducive to promoting the construction of the ordered health delivery system, especially the ordered division of labor among medical institutions at different levels [29][30][31][32][33]. This omission stems from prior research disregarding the influence of the Medical Institution Rank Coefficient (MIRC) within the DIP system, which reflects differences in overall costs among medical institutions.…”

Section: Introductionmentioning

confidence: 99%

Does a new case-based payment system promote the construction of the ordered health delivery system? Evidence from a pilot city in China

Shi,

Cheng,

Liu

et al. 2024

Int J Equity Health

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Background The construction of the ordered health delivery system in China aims to enhance equity and optimize the efficient use of medical resources by rationally allocating patients to different levels of medical institutions based on the severity of their condition. However, superior hospitals have been overcrowded, and primary healthcare facilities have been underutilized in recent years. China has developed a new case-based payment method called “Diagnostic Intervention Package” (DIP). The government is trying to use this economic lever to encourage medical institutions to actively assume treatment tasks consistent with their functional positioning and service capabilities. Methods This study takes Tai’an, a DIP pilot city, as a case study and uses an interrupted time series analysis to analyze the impact of DIP reform on the case severity and service scope of medical institutions at different levels. Results The results show that after the DIP reform, the proportion of patients receiving complicated procedures (tertiary hospitals: β3 = 0.197, P < 0.001; secondary hospitals: β3 = 0.132, P = 0.020) and the case mix index (tertiary hospitals: β3 = 0.022, P < 0.001; secondary hospitals: β3 = 0.008, P < 0.001) in tertiary and secondary hospitals increased, and the proportion of primary-DIP-groups cases decreased (tertiary hospitals: β3 = -0.290, P < 0.001; secondary hospitals: β3 = -1.200, P < 0.001), aligning with the anticipated policy objectives. However, the proportion of patients receiving complicated procedures (β3 = 0.186, P = 0.002) and the case mix index (β3 = 0.002, P < 0.001) in primary healthcare facilities increased after the reform, while the proportion of primary-DIP-groups cases (β3 = -0.515, P = 0.005) and primary-DIP-groups coverage (β3 = -2.011, P < 0.001) decreased, which will reduce the utilization efficiency of medical resources and increase inequity. Conclusion The DIP reform did not effectively promote the construction of the ordered health delivery system. Policymakers need to adjust economic incentives and implement restraint mechanisms to regulate the behavior of medical institutions.

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Impacts of a New Episode-Based Payment Scheme on Volume, Expenditures, and Efficiency in Public Hospitals: A Quasi-Experimental Interrupted Time-Series Study in Jinhua, China

Cited by 7 publications

References 25 publications

Impacts of Outpatient Payment Reforms on Volume and Expenditures in Public Hospitals: Evidence from a Quasi-Experimental Analysis in Zhejiang, China

Impacts of Outpatient Payment Reforms on Volume and Expenditures in Public Hospitals: Evidence from a Quasi-Experimental Analysis in Zhejiang, China

A Bibliometric Analysis of Diagnosis Related Groups from 2013 to 2022

Does a new case-based payment system promote the construction of the ordered health delivery system? Evidence from a pilot city in China

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