How do inpatients’ costs, length of stay, and quality of care vary across age groups after a new case-based payment reform in China? An interrupted time series analysis
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<jats:title>Abstract</jats:title><jats:sec> <jats:title>Context</jats:title> <jats:p>A patient classification-based payment system called diagnosis-intervention packet (DIP) was piloted in a large city in southeast China in 2018.</jats:p> </jats:sec><jats:sec> <jats:title>Objective</jats:title> <jats:p>This study evaluates the impact of DIP payment reform on total costs, out-of-pocket (OOP) payments, length of stay (LOS), and quality of care in hospitalised patients of different age.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>An interrupted time series model was employed to examine the monthly trend changes of outcome variables before and after the DIP reform in adult patients, who were stratified into a younger (18–64 years) and an older group (≥ 65 years), further stratified into young-old (65–79 years) and oldest-old (≥ 80 years) groups.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>The adjusted monthly trend of costs per case significantly increased in the older adults (0.5%, <jats:italic>P</jats:italic> = 0.002) and oldest-old group (0.6%, <jats:italic>P</jats:italic> = 0.015). The adjusted monthly trend of average LOS decreased in the younger and young-old groups (monthly slope change: -0.058 days, <jats:italic>P</jats:italic> = 0.035; -0.025 days, <jats:italic>P</jats:italic> = 0.024, respectively), and increased in the oldest-old group (monthly slope change: 0.107 days, <jats:italic>P</jats:italic> = 0.030) significantly. The changes of adjusted monthly trends of in-hospital mortality rate were not significant in all age groups.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Implementation of the DIP payment reform associated with increase in total costs per case in the older and oldest-old groups, and reduction in LOS in the younger and young-old groups without deteriorating quality of care.</jats:p> </jats:sec>
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Chen, Ya-Jing, Xin-Yu Zhang, Xue Tang, Jia-Qi Yan, Meng-Cen Qian and Xiao-Hua Ying (n.d.). How do inpatients’ costs, length of stay, and quality of care vary across age groups after a new case-based payment reform in China? An interrupted time series analysis. BMC Health Services Research, 23(1). 10.1186/s12913-023-09109-z Retrieved from https://hdl.handle.net/10161/31273.
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