The effects of diagnosis-related groups payment on hospital healthcare in China: a systematic review

Abstract

Background There has been a growing interest in using diagnosis-related groups (DRGs) payment to reimburse inpatient care worldwide. But its effects on healthcare and health outcomes are controversial, and the evidence from low- and middle- income countries (LMICs) is especially scarce. The objective of this study is to evaluate the effects of DRGs payment on healthcare and health outcomes in China. Method A systematic review was conducted. We searched literature databases of PubMed, Cochrane Library, EMBASE, Web of Science, Chinese National Knowledge Infrastructure and SinoMed for empirical studies examining the effects of DRGs payment on healthcare in mainland China. We performed a narrative synthesis of outcomes regarding expenditure, efficiency, quality and equity of healthcare, and assessed the quality of evidence. Results Twenty-three publications representing thirteen DRGs payment studies were included, including six controlled before after studies, two interrupted time series studies and five uncontrolled before-after studies. All studies compared DRGs payment to fee-for-service, with or without an overall budget, in settings of tertiary (7), secondary (7) and primary care (1). The involved participants varied from specific groups to all inpatients. DRGs payment mildly reduced the length of stay. Impairment of equity of healthcare was consistently reported, especially for patients exempted from DRGs payment, including: patient selection, cost-shifting and inferior quality of healthcare. However, findings on total expenditure, out of pocket payment (OOP) and quality of healthcare were inconsistent. The quality of the evidence was generally low or very low due to the study design and potential risk of bias of included studies. Conclusion DRGs payment may mildly improve the efficiency but impair the equity and quality of healthcare, especially for patients exempted from this payment scheme, and may cause up-coding of medical records. However, DRGs payment may or may not contain the total expenditure or OOP, depending on the components design of the payment. Policymakers should very carefully consider each component of DRGs payment design against policy goals. Well-designed randomised trials or comparative studies are warranted to consolidate the evidence of the effects of DRGs payment on healthcare and health outcomes in LMICs to inform policymaking.

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

“…Previous DRG studies in China have paid more attention to cost control, thereby paying less attention to provider behavior. 16 The few existing papers that have mentioned change of the provider’s behavior under DRG in China are either theoretic works 2 , 17 or single case analyses which were difficult to achieve a comprehensive assessment. 3 , 18 , 19 Moreover, no prior report has presented the effects of the DRGs on providers’ behavior from the physicians’ perspectives.…”

The Impact of China's Total Medical Insurance Package Payment Based on Compact County Medical Community and Its Implications for Medical Insurance Funds: Evidence from Y County, China

“…For example, the medical quality of member units is included in the assessment content, and the assessment is carried out by an expert group. The result is linked to the allocation index of the next year's medical insurance fund, So as to curb member units from conducting bad medical behaviors in order to control MIE.In previous studies, researchers mainly evaluated the practice of medical insurance payment methods such as DRGs and global payment in China [11][12][13].However, the reform of the medical insurance system in Y County is a new policy design that has been strongly promoted by the Chinese government.Therefore, there is still a lack of strong evidence to evaluate the effect of CCMC-based TMIPP in China, and there is no report on the impact of the reform on the operation of medical institutions.This research takes Y County as an example, and uses Interrupted Time Series(ITS) to analyze the impact of CCMC-based TMIPP reform on the utilization and expenditure of county-level medical institutions and basic health service centers, as well as the impact on the overall level of inpatient service utilization and expenditure of inpatient institutions outside the CCMC.Provide reference for the further implementation of reform.…”

Urban-rural differences in healthcare utilization among beneficiaries in China’s new cooperative medical scheme

“…The answer to the cost question appeared to depend on the components designed in the DRG payment model. The authors concluded that policymakers should very carefully consider each component of DRGs payment design against policy goals and suggested well-designed randomized trials or comparative studies would help strengthen the evidence [ 30 ].…”