Impacts of Diagnosis-Related Groups Payment on the Healthcare Providers’ Behavior in China: A Cross-Sectional Study Among Physicians

Abstract

Purpose Currently, China is piloting diagnosis-related groups (DRG) payment system in 30 cities. The main aim of this study was to explore the respondents’ impressions regarding the hospitals’ policies and physicians’ behavior change brought by the DRG payment system, and investigate whether and how the hospitals’ policies affect the physicians’ behavior. Methods We distributed questionnaires designed for this study to 200 physicians. Data analysis consisted of descriptive statistics, T -test, and network analysis. Results Respondents stated that the hospitals had adopted several policies in response to DRG payment and DRG payment could reduce overtreatment and improve efficiency. However, it also led to several negative effects including an increased explanation to the patients, hindering new technologies, case splitting, and cherry picking. In addition, there was no evidence that harmful effects such as refusing patients and premature discharge existed. Overall, the benefits outweighed the drawbacks of DRG. Moreover, the hospitals’ policies could effectively change physician behaviors. Our results indicated that promoting the implementation of clinical pathways had the most positive impact, while limiting costs and length of stay is not recommended. Conclusion In general, Chinese physicians who participated in the questionnaire possessed relatively positive attitudes towards the DRG payment system. Nevertheless, some of the negative impacts cannot be ignored. Meanwhile, the hospitals’ policies should be implemented with adequate consideration of the impact on physicians’ behavior.

Exploring the effects of the withdrawal of the capitation policy on Cesarean rates in public hospitals in Ghana: an interrupted time series analysis

“…Ghana's primary care capitation was replaced with the G-DRG which was introduced in 2008. The non-significant trend increase in CS may have reflected possible tendencies for the DRG payment system to curb overtreatment in hospitals (41). The increased trend of ANC4+ post capitation withdrawal confirms the increased provision of services attributable to any DRG payment system (42) although this did not translate into an expected decrease in CS rates.…”

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

“…Health providers are incentivized to actively control costs and avoid potential revenue loss, because shifting from FFS to this new case-based payment scheme with a regional global budget generated significantly increased financial risks. 6,23 However, the hospital expenditure in the Chinese health insurance system consists of insurance payments and OOP payments. When the case-based payment method was only applied to insurance payments but not to the total hospital expenditures or OOP payments, the risk of cost-shifting to OOP payments may occur.…”

Challenges of implementing diagnostic‐related groups and healthcare promotion in Iran: A strategic applied research

“… 14 , 15 Studies have shown that, in addition to the benefits of using DRGs in reducing overuse of health services, reducing the length of stay, and controlling treatment costs, it has led to unintended consequences such as reduced quality of care, dumping, the need for recoding, and frequent hospitalizations. 16 , 17 …”