DRG payment, financial signals, and low-value hospitalizations in China
Bibliographic Data
| ID | 22088990 |
|---|---|
| Authors | Lixiang Wu (0000-0003-0571-454X, Wenzhou Medical University), Ni Wu (0000-0003-0751-3047, Sichuan University), Lihong Lin (Wenzhou Medical University), Qin Ying (0000-0002-7676-1784, Wenzhou Medical University), Xiaoyuan Zhou (0000-0002-0930-1278, Sichuan University), Yangyang Zhu (0009-0007-1635-9471, Wenzhou Medical University, corresponding author) |
| Year | 2026 |
| Volume | 14 |
| Pages | 1797063-1797063 |
| Publication date | 2026-05-05 |
| 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.2026.1797063 |
| PMID | 42163925 |
| OpenAlex | W7160252480 |
| Language | EN |
| References cited | 25 |
Objective: To examine whether China's Diagnosis-Related Group (DRG) payment reform is associated with low-value inpatient admissions-defined as entire hospitalizations of questionable necessity-and to identify the primary drivers of this type of care. Methods: We developed a new rule to identify low-value admissions using claims data, synthesizing international standards and Chinese health policies. We conducted a analysis of all DRG payment records (2022-2024, N = 251,811) from a large tertiary hospital in a region that adopted the reform early. A multilevel mixed-effects logistic regression model was applied, with the DRG Medical Expense Ratio (DER)-a measure of profitability at the case level-as the key explanatory variable. Results: The overall incidence of low-value hospitalizations was 4.86% and rose by 76.5% from 2022 to 2024, resulting in insurance expenditures of 51.23 million Chinese Yuan. Admissions with the highest profit margins (low DER) were significantly more likely to be low-value (high vs. low DER: OR = 0.056). By 2024, 80.74% of low-value cases were classified as "check-up dominated" admissions. Conclusion: Within the DRG payment environment in China, the financial incentives created by the reform are associated with hospitals admitting patients for low-value, low-complexity care, effectively shifting rather than eliminating waste in the healthcare system
China · Diagnosis-related group · Health care · Health insurance · Incentive · Logistic regression · Payment · Profitability index · Healthcare cost, quality, practices · Healthcare Policy and Management · Primary Care and Health Outcomes
Years of health-care reform in China
Evidence for overuse of medical services around the world
Knowledge, attitudes, and practices regarding China’s DRG payment policy among healthcare professionals in tertiary and secondary hospitals in Yunnan Province
Wasting resources in health care – unnecessary hospitalisations and over-medicalisation
The Evolving Hospital Market in China After the 2009 Healthcare Reform
| Highly cited | No |
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