Impact analysis of the payment reform of “same disease with the same price in the same level of hospital” diagnosis-related group based on L City, Guizhou Province: an empirical study

Abstract

BackgroundDiagnosis-related group (DRG)-based payment system has been widely implemented in China to improve hospital efficiency, standardise the behaviours of health-care providers, and control the increase of medical costs. In order to study the impact of the DRG reform strategy “same disease with the same price in the same level of hospital” on the costs control of medical institutions, we analysed changes in the level and trend of hospitalisation expenses before and after the implementation of the new rural cooperative medical insurance DRG-based payment reform. MethodsWe collected medical insurance claims data of four pilot hospitals implementing DRG-based payment reform in L City, Guizhou Province, from Jan 1, 2016, to July 31, 2018, including 141 987 cases. Hospitals A and B were tertiary hospitals, and hospitals C and D were secondary hospitals. Taking October 2017 as the intervention point, we used interrupted time series (ITS) and qualitative interview methods to evaluate the policy effect. FindingsBefore the reform, the costs per case of hospital A and hospital B were higher than that of tertiary hospitals, and hospital A also had the highest increase in the costs per case. After the reform, the growth rate of costs per case declined by ¥43·98 per month in hospital A, while that increased by ¥5·91 per month in hospital B. The growth rate of costs per case in hospital A decreased much more obviously than that in hospital B. Before the reform, the costs per case of hospital C were slightly higher than the average costs level of secondary hospital, while the costs per case of hospital D were lower than the average level. After the reform, the increase of costs per case in hospital C has changed from ¥41·40 per month to ¥ 109·73 per month, and the long-term growth trend has not been controlled. The increase of costs per case in hospital D was ¥32·03 per month, which was smaller than that of hospital C. In terms of total costs, the growth rate of hospital A and hospital D increased by ¥66 000 per month and ¥154 000 per month, respectively, which was smaller than that of hospital B (¥788 900 per month) and hospital C (¥158 300 per month). InterpretationThis DRG-based payment reform strategy has set up the overall costs benchmark of the hospitals at the same level, which has prompted providers to take the initiative to pay attention to costs. And the reform was also beneficial to curb the hospitals that pushed up the costs in the first place. After the reform, the overall costs control of pilot hospitals has not changed significantly, it is still necessary to continue to track the impact of the reform on all kinds of hospitals at all levels in the city. FundingNew rural cooperative medical system (NCMS) payments reform contact point project of Grass-roots Department of the National Health Commission (2209121).