Abstract
Background
One of the important ways to reduce medical costs and improve quality of care is to enable physicians to provide standard medical services according to clinical guidelines, and the medical payment system is a significant means of guiding the behaviour of health service providers. This study aims to investigate whether the diagnosis-related group (DRG) payment system can improve the consistency of health services.
Method
Inpatients with three types of disease—chronic obstructive pulmonary disease (COPD), acute myocardial infarction (AMI) and cerebral infarction (CI)—were enrolled from 25 county-level hospitals in a DRG pilot city in China. Inpatients from hospitals that implemented DRG payment were selected as the intervention group, and similar inpatient cases from hospitals that still implemented fee-for-services (FFS) payment were designated as the control group. A propensity matching score (PSM) was used for data matching to control for age, gender and disease severity. The variation of hospitalization expenditures and their trends before and after implementation of the DRG policy were described by using these matched samples.
Results
After DRG implementation, the standard deviation (SD) of hospitalization expenditures in the COPD, AMI and CI intervention groups decreased by 11094 yuan, 4833 yuan and 425 yuan, respectively, which were 5972, 2484, and 2938 yuan more than that in the control group. In each year after DRG implementation, the interquartile range (IQR) of hospitalization expenditures was smaller in DRG group than that in FFS group. In most years, the degree of variation in costs of the intervention group decreased more than that of the control group. The medians of hospitalization expenditures of the intervention groups were lower than the fixed cost, while most medians of the control groups were higher than the fixed cost.
Conclusion
A comparison of patients with similar demographics and disease characteristics revealed that patients in the DRG group experienced a smaller degree of variation in hospitalization expenditures, and indicated the expenditures had a tendency to become progressively more concentrated over time. It is suggested that DRG system can promote better consistency in health services and reduce medical costs.
Early results of pediatric appendicitis after adoption of diagnosis-related group-based payment system in South Korea