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Open Access 01-12-2024 | Uvulopalatopharyngoplasty | Research

Analysis of the impact of China Healthcare Security diagnosis-related groups payment reform on the hospitalization costs for uvulopalatopharyngoplasty in obstructive sleep apnea patients at Hospital C

Authors: Mengying Li, Jing Yang, Jiyong Shen, Jinkun Xu, Debin Gu

Published in: BMC Health Services Research | Issue 1/2024

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Abstract

Background

As part of China’s medical insurance-related grouping payment reform, public hospitals, which are the primary providers of medical insurance services, face remarkable pressure to control costs. This study examined uvulopalatopharyngoplasty (UPPP) surgery for patients with obstructive sleep apnea (OSA) at Hospital C to identify factors influencing inpatient costs and assess the impact of payment reform on treatment practices.

Methods

Using data from 251 OSA patients undergoing UPPP at Hospital C, the study evaluated changes in cost reduction, cost structure, patient disease severity, and medical quality before and after the payment reform.

Results

Inpatient costs for OSA patients undergoing UPPP surgery significantly decreased following the trial implementation of CHS-DRG, with notable reductions in medication and consumable expenses, as well as a shorter length of hospitalization. The CHS-DRG reform did not affect illness severity, patient safety during hospitalization, or long-term surgical outcomes for OSA patients.

Conclusion

After the CHS-DRG reform, Hospital C proactively adjusted clinical pathways to manage costs and improve inpatient turnover efficiency without resorting to cost-shifting, patient refusal, or staged surgeries. Despite the financial pressures, hospitals should aim to establish a win-win mechanism between hospitals, physicians, and patients, enhance internal management, and improve financial performance. Additionally, medical security authorities should explore more precise DRG payments and value-based payment models to promote high-quality hospital development rather than impose constraints.

Study approval

This study was approved by the Ethics Committee of Beijing Tsinghua Changgung Hospital (Approval No. 23418-0-02).
Appendix
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Literature
1.
Li Y, Zhang Y, Wan Q, et al. 2020 China’s total health expenditure accounting results and analysis. Health Econ Res. 2022;39(01):2–6.
2.
3.
Goldfield N. The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital. Qual Manag Health Care. 2010;19(1):3–16.CrossRefPubMed
4.
Jinming F. Game analysis and empirical study of stakeholders under DRG payment. Huazhong University of Science and Technology; 2021.
5.
Li Hao TH, Institutional, Environment. Logical motivation, and Formation Mechanism of Low Coding and high encoding under DRG: a perspective of pressure-contradiction transfer. Social Secur Res. 2022;06:64–77.
6.
Mihrshahi S, Brand C, Ibrahim JE, et al. Validity of the indicator ‘death in low-mortality diagnosis-related groups’ for measuring patient safety and healthcare quality in hospitals. Intern Med J. 2010;40(4):250–7.CrossRefPubMed
7.
Han Jinsong LC. Analysis of medical expenses for inpatients from different places and Local Areas under DRG payment: an empirical analysis based on a Tumor Hospital. Chin Med Insurance. 2023;01:55–8.
8.
Li Y, Zeng ZD. Judicial assessment of the irrationality of medical expenses. Chin J Forensic Med. 2014;29(02):181–2.
9.
Scheller-Kreinsen D, Quentin W, Busse R. DRG-Based Hospital Payment Systems and Technological Innovation in 12 European countries. Value Health. 2011;14(8):1166–72.CrossRefPubMed
10.
Association SMPCoCM. Multidisciplinary diagnosis and treatment guidelines for adult obstructive sleep apnea. Chin Med J. 2018;98(24):1902–14.
11.
12.
13.
Wang Hui ZG, Yu F. Potential risks and countermeasures of DRG payment. Health Econ Res. 2020;37(07):14–5.
14.
Cao Y, Dang C, Li H et al. Chinese expert recommendations on the diagnosis and treatment of acute cerebral infarction under diagnosis-related groups or diagnosis-treatment bundle payment methods. Chin J Neurol Mental Dis. 2023;49(01):1−10
15.
Zhang L. Research on the impact of Medical Insurance Payment Reform on Medical Behavior. Shenyang Pharmaceutical University; 2021.
16.
Xu Q, Zhang Z, Gong Y, et al. Necessity and feasibility study of including inter-provincial medical treatment in DRG payment. China Health Insurance. 2022;10:58–62.
17.
Ma C, Du Y, Tang R, et al. Reform of DIP payment method, control of medical expenses and short-term strategic response of hospitals. World Econ. 2022;45(11):177–200.
18.
Zou K, Li HY, Zhou D, et al. The effects of diagnosis-related groups payment on hospital healthcare in China: a systematic review[J]. BMC Health Serv Res. 2020;20(1):112.CrossRefPubMedPubMedCentral
19.
Mcmahon LJ. Diagnosis-related group prospective payment. Effects on medical quality assurance[J]. Eval Health Prof. 1984;7(1):25–41.CrossRefPubMed
20.
Wenke A, Muller ML, Babapirali J, et al. Development of lengths of stay and DRG cost weights in dermatology from 2003 to 2006[J]. J Dtsch Dermatol Ges. 2009;7(8):680–7.PubMed
21.
Kalanj K, Marshall R, Karol K, et al. The effects of diagnosis-related groups payment on efficiency of the hospital health care in Croatia[J]. Croat Med J. 2021;62(6):561–8.CrossRefPubMedPubMedCentral
22.
Zhao YY, et al. Cost and related factors analysis for patients undergoing colon polyp surgery based on DRG mode. Eur Rev Med Pharmacol Sci. 2023;27(16):7582–9.
23.
Karol Karl, et al. The importance of good governance in hospital payment reform – A case study from Ukraine. Health Policy OPEN 4. 2023:100089–100089.CrossRef
Metadata
Title
Analysis of the impact of China Healthcare Security diagnosis-related groups payment reform on the hospitalization costs for uvulopalatopharyngoplasty in obstructive sleep apnea patients at Hospital C
Authors
Mengying Li
Jing Yang
Jiyong Shen
Jinkun Xu
Debin Gu
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-024-11997-8

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