Variations in the impact of the new case-based payment reform on medical costs, length of stay, and quality across different hospitals in China: an interrupted time series analysis

dc.contributor.author

Tang, Xue

dc.contributor.author

Zhang, Xinyu

dc.contributor.author

Chen, Yajing

dc.contributor.author

Yan, Jiaqi

dc.contributor.author

Qian, Mengcen

dc.contributor.author

Ying, Xiaohua

dc.date.accessioned

2024-07-16T02:14:19Z

dc.date.available

2024-07-16T02:14:19Z

dc.description.abstract

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>In 2018, an innovative case-based payment scheme called Diagnosis-Intervention Packet (DIP) was piloted in a large developed city in southern China. This study aimed to investigate the impact of the new payment method on total medical expenditure per case, length of stay (LOS), and in-hospital mortality rate across different hospitals.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We used the de-identified patient-level discharge data of hospitalized patients from 2016 to 2019 in our study city. The interrupted time series model was used to examine the impact of the DIP payment reform on inflation-adjusted total expenditure per case, LOS, and in-hospital mortality rate across different hospitals, which were stratified into different hospital ownerships (public and private) and hospital levels (tertiary, secondary, and primary).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We included 2.08 million and 2.98 million discharge cases of insured patients before and after the DIP payment reform, respectively. The DIP payment reform resulted in a significant increase of the monthly trend of adjusted total expenditure per case in public (1.1%,<jats:italic>P</jats:italic> = 0.000), tertiary (0.6%,<jats:italic>P</jats:italic> = 0.000), secondary (0.4%,<jats:italic>P</jats:italic> = 0.047) and primary hospitals (0.9%,<jats:italic>P</jats:italic> = 0.039). The monthly trend of LOS increased significantly in public (0.022 days,<jats:italic>P</jats:italic> = 0.041) and primary (0.235 days,<jats:italic>P</jats:italic> = 0.032) hospitals. The monthly trend of in-hospital mortality rate decreased significantly in private (0.083 percentage points,<jats:italic>P</jats:italic> = 0.002) and secondary (0.037 percentage points,<jats:italic>P</jats:italic> = 0.002) hospitals.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>We conclude that implementing the DIP payment reform yields inconsistent consequences across different hospitals. DIP reform encouraged public hospitals and high-level hospitals to treat patients with higher illness severities and requiring high treatment intensity, resulting in a significant increase in total expenditure per case. The inconsistencies between public and private hospitals may be attributed to their different baseline levels prior to the reform and their different responses to the incentives created by the reform.</jats:p></jats:sec>

dc.identifier.issn

1472-6963

dc.identifier.uri

https://hdl.handle.net/10161/31272

dc.language

en

dc.publisher

Springer Science and Business Media LLC

dc.relation.ispartof

BMC Health Services Research

dc.relation.isversionof

10.1186/s12913-023-09553-x

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.title

Variations in the impact of the new case-based payment reform on medical costs, length of stay, and quality across different hospitals in China: an interrupted time series analysis

dc.type

Journal article

duke.contributor.orcid

Zhang, Xinyu|0000-0002-5979-244X

pubs.issue

1

pubs.organisational-group

Duke

pubs.publication-status

Published online

pubs.volume

23

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