The impacts of diagnosis-intervention packet payment on the providers’ behavior of inpatient care—evidence from a national pilot city in China

Abstract

BackgroundIn 2020, the Chinese government developed and implemented an innovative case-based payment method under the regional global budget called the diagnosis-intervention packet (DIP) payment to pay for inpatient care. This study aims to assess the changes to inpatient care provision in hospitals after the DIP payment reform was implemented.MethodsThis study used inpatient medical costs per case, the proportion of the out-of-pocket (OOP) expenditure in inpatient medical costs, and the average length of stay (LOS) of inpatient care as outcome variables, and conducted an interrupted time series analysis to evaluate changes after the DIP payment reform. January 2021 was taken as the intervention point when a national pilot city of the DIP payment reform in the Shandong province began using the DIP payment to pay for inpatient care of secondary and tertiary hospitals. The data used in this study were obtained from the aggregated monthly claim data of inpatient care of secondary and tertiary hospitals.ResultsCompared to the pre-intervention trend, the inpatient medical costs per case, the proportion of the OOP expenditure in inpatient medical costs both in tertiary and secondary hospitals significantly decreased after the intervention. After the intervention, the reduction in the inpatient medical costs per case, the proportion of the OOP expenditure in inpatient medical costs in tertiary hospital were both higher than those in secondary hospital (p < 0.001). The average LOS of inpatient care in secondary hospital significantly increased after the intervention, and it immediately increase 0.44 day after intervention (p = 0.211). Moreover, the change of average LOS of inpatient care in secondary hospital after intervention was opposite to that in tertiary hospital, it had no statistical difference (p = 0.269).ConclusionIn the short term, the DIP payment reform could not only effectively regulate provider behavior of inpatient care in hospitals, but also improves the rational allocation of the regional healthcare resources. However, the long-term effects of the DIP payment reform need to be investigated in the future.

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

“…Regarding the analysis method, we were unable to apply the difference-in-differences method because the medical institutions of Zhejiang Province, that could pay for basic medical insurance funds, were all required to implement the DRG payment policy, including Wenzhou. In addition, we could not obtain data from the public general hospitals outside Zhejiang Province where the DRG or other payment reforms (like the Diagnosis Intervention Packet payment 49 ) were not implemented, under the process of the nationwide payment reform. Fortunately, R-MITS is an optimised version of ITS, the strengths of which include enhancing the relationship between the evolution of results and the intervention of study.…”

Effects of a Diagnosis-Related Group Payment Reform on Length and Costs of Hospitalization in Sichuan, China: A Synthetic Control Study

“…This strategy not only aims to reduce the economic burden on the government and society but also to improve the quality and accessibility of health care for the population. 6 and 0.69 nurses, respectively. 30 In March 2018, Panzhihua became the first city in Sichuan to implement the reform of disease diagnosis-related groups (DRG) combined with the point method of cost payment under a total budget.…”

“…This strategy not only aims to reduce the economic burden on the government and society but also to improve the quality and accessibility of health care for the population. 6 …”

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

“…DIP is a Chinese original payment method. 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 – 33 ].…”