Can DRG payment under global budget with price adjustment curb the soaring healthcare costs? Insights from China’s reform and its underlying mechanism

作者：Xinyue Dong, Xiaoning He, Jing Wu · 发表于：BMC Public Health · 年份：2025 · DOI：10.1186/s12889-025-25236-0 · 被引用次数：7 · 研究领域：Healthcare Systems and Reforms、Healthcare Policy and Management、Global Maternal and Child Health

BACKGROUND: This study aims to explore hospital responses to incentives under the China Healthcare Security Diagnosis-Related Group (CHS-DRG) system, the first nationwide DRG-based bundled payment initiative in China, which is designed to stimulate the integration of health services and then contain the medical expenditure inflation. METHODS: Zooming in all insured cases during November 2021 to September 2022, we assessed the impacts of CHS-DRG program under the regional global budget with price adjustment in Tianjin, China upon costs and its underlying mechanism through a difference-in-differences (DID) strategy. A total of 932 354 cases were admitted in the intervention group and 608 940 were in control. Key outcomes included per-admission spending, out-of-pocket payments, reimbursements and total monthly healthcare expenditures from a societal perspective. Additionally, the monthly number of admissions per hospital was analyzed to assess care intensity, while length-of-stay and 30-day readmission rates were employed to examine treatment efficiency and care quality. Robustness checks and common trends tests were performed to validate the findings. RESULTS: The implementation of CHS-DRG led to a significant reduction in per-admission spending by 1.63% (P = 0.002) encompassing decrease in reimbursements of 2.45% (P < 0.001) and out-of-pocket payments of 2.50% (P < 0.001), which was mainly attributable to the cost structure changes, including declines in drug and treatment cos...