Cost shifting or cost cutting by hospitals as a response to reimbursement reform? The case of diagnosis-related groups (DRG) scheme in China
Bibliographic Data
| ID | 22081199 |
|---|---|
| Authors | Jiabi Wang (0000-0003-4503-5023, Macau University of Science and Technology), Jinyun Zhu (Macau University of Science and Technology), Kuan Hu (0000-0002-8698-1369, Macau University of Science and Technology), Yijun Chen (0009-0004-9866-8902, Macau University of Science and Technology), Jinghua Zhang (0000-0002-9390-5970, Macau University of Science and Technology, corresponding author), Xiaoyu Wu (0000-0003-3803-7207, Macau University of Science and Technology, corresponding author) |
| Year | 2025 |
| Volume | 13 |
| Pages | 1582001-1582001 |
| Publication date | 2025-08-20 |
| Peer Reviewed | Yes |
| 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.2025.1582001 |
| PMID | 40910049 |
| OpenAlex | W4413343246 |
| Language | EN |
| Citations received | 1 |
| References cited | 62 |
Background: Diagnosis-related group (DRG) systems for healthcare reimbursement were recently introduced among hospitals in China, raising concerns about cost-shifting, where hospitals may increase charges for self-financing patients to offset reimbursement cuts by DRG. In 2018, both Nanchang and Ganzhou Cities in Jiangxi Province installed DRG information systems, but only Nanchang fully implemented the DRG system during the 2019-2020 pilot period. Materials and methods: Drawing from a healthcare administrative dataset of 14,310 patients' records, this study investigates the hospitalization costs associated with Intraocular Lens (IOL) implantation procedures in Jiangxi Province, China, from 2017 to 2020. By applying the quantile difference-in-differences (DID) and difference-in-difference-in-difference (DDD) methodologies, the research examines the impacts of DRG implementation on hospitalization costs, with a particular focus on self-financing patients. Results: ). The DDD model revealed a decrease of 0.226 in the IOL cost ratio for self-financing patients in DRG hospitals post-implementation. These results remained robust across various healthcare cost ratios. Conclusion: The study indicates that implementing the DRG system in Chinese hospitals effectively constrained healthcare costs without causing unintended cost-shifting among self-financing patients. The system's heightened impacts on higher quantiles indicate its efficacy in addressing high-cost outliers. These outcomes are likely attributed to the centralized medical procurement and healthcare information technology integrated into the Chinese healthcare system
Business · China · Diagnosis-related group · Economic growth · Economics · Geography · Health care · Healthcare system · Medical emergency · Reimbursement · Significant difference · Health Systems, Economic Evaluations, Quality of Life · Healthcare Policy and Management · Healthcare Systems and Reforms · Medicine · Emergency Medicine · Finance
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| Unique citing works | 1 |
|---|---|
| Citations per year | 1 |
| Citation span | 2025 - 2025 (1) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 1 |