Clinical and economic impacts of a clinical pathway-based single disease payment policy on hysterectomy for uterine fibroids
A decade-long interrupted time series analysis
Bibliographic Data
| ID | 22067904 |
|---|---|
| Authors | Hui Zheng (0000-0002-7217-5032, Fujian Medical University), Zelong Li (0000-0002-5322-5065, Fujian Medical University), Hang Lin (0009-0007-6300-4729, Fujian Medical University), Huan Yi (0009-0009-9209-916X, Fujian Medical University, corresponding author), Xiangqin Zheng (Fujian Medical University, corresponding author) |
| Year | 2026 |
| Volume | 14 |
| Pages | 1751890-1751890 |
| Publication date | 2026-03-18 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Frontiers in Public Health (JOURNAL) |
| Journal identifiers | ISSN: 2296-2565 • E-ISSN: 2296-2565 |
| Publisher | Frontiers Media SA (PUBLISHER • CH) |
| DOI | 10.3389/fpubh.2026.1751890 |
| PMID | 41929881 |
| OpenAlex | W7138846245 |
| Language | EN |
| References cited | 15 |
Objective: In 2017, China introduced clinical pathway-based single disease payment (CP-SDP) to curb healthcare costs, yet its impact is uncertain. Using uterine fibroids as a case, we evaluated its effectiveness. Methods: We analyzed 4,727 hysterectomy cases for uterine fibroids from a tertiary hospital in Fujian Province between January 2014 and December 2023. Using an interrupted time series (ITS) with August 2017 as the intervention point, we fitted a segmented regression model to estimate immediate level changes and post-intervention trends. The impact of CP-SDP was evaluated across structure, process, and clinical outcome domains. Results: The utilization of laparoscopic surgery significantly increased from 45.1 to 75.5%, accompanied by 3.51 days reduction in average hospital stay. Significant changes had occurred in the cost structure: technical service fees (e.g., pathological diagnostics [+32.4%] and imaging [+7.3%]) increased, whereas consumable costs (e.g., antibacterial drugs [-48.5%] and disposable supplies [-19.5%]) decreased significantly. Hospitalization expenses decreased by 2.7%, while the postoperative complication rate decreased from 7.8 to 4.9%. ITS analysis showed that after the policy, hospitalization expenses immediately decreased by 2265.51 ¥ (13.28%) and continued to decrease. The long-term trend of out of pocket expenses had shifted from increasing to decreasing, and the proportion of medical insurance reimbursement had shifted from decreasing to increasing. In 2023, out-of-pocket expenses had reached their lowest level, whereas the reimbursement ratio had peaked. Conclusion: CP-SDP appears to control costs while improving care quality by promoting minimally invasive procedures and optimizing cost allocation. This approach substantially reduces patients' long-term financial burden
Endometrial cancer · Hysterectomy · Interrupted time series · Interrupted Time Series Analysis · Medical expenses · Payment · Reimbursement · Uterine fibroids · Economic and Financial Impacts of Cancer · Endometrial and Cervical Cancer Treatments · Uterine Myomas and Treatments
Years of health-care reform in China
Interrupted time series regression for the evaluation of public health interventions
Can single disease payment impact hospitalization expenses and quality in district hospital? A case study in Fujian, China
Hospital response to a case-based payment scheme under regional global budget
| Highly cited | No |
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