Do the effects of the DIP payment reform work for patients in the same city who are not yet covered by the reform? Evidence from Guangzhou, China

Abstract

Abstract Background The Reform of medical insurance payment methods is one of the crucial measures for controlling irrational medical practices. In China, the National Health Insurance Administration requires a full switch from the existing fee-for-service payment to DRG or DIP payments by 2025. Guangzhou, a city with a more developed economy and abundant medical resources in China, has completed the DIP payment reform for local-insured patients since 2018. However, patients from other-insured-region have not yet been included in the reform and still retain fee-for-service payment. This paper intends to prove that if DIP payment reform for local patients has made some effects and can these effects be simultaneously applied to the other-insured-region patients who are not covered by the payment reform. Methods The data in this paper were obtained from the database of basic medical insurance for urban employees of local and the other-insured-region patients in Guangzhou provided by the Guangzhou Healthcare Security Administration from 2017 to 2019. We used the average inpatient cost and the average rate of cost belonging to the medical insurance catalog to evaluate the changes in inpatient costs and reimbursement levels for both groups of patients before and after implementing the DIP payment reform. Single-group and multi-group interrupted time series were used to analyze the indicators. Results (1) After the DIP payment reform, local patients’ average inpatient costs fluctuated less between months compared with those before the policy implementation. (2) The average rate of cost belonging to the medical insurance catalog for local patients reflected a short- and long-term decreasing trend after the policy implementation, suggesting that patients’ burden increased and patients failed to enjoy the reform dividends. (3) The average inpatient costs of the other-insured-region patients were higher than those of local patients before and after the policy. The restraining effect on medical costs of the other-insured-region patients was not significant. (4) The average rate of cost belonging to the medical insurance catalog of the other-insured-region patients was lower than that of local patients, and after the implementation of the policy, although this indicator showed a significant downward trend in the long-term trend, but for some diseases was equal to or even higher than that of local patients. Conclusions On one hand, DIP payment reform for local patients has achieved some success, but still need further strengthening of regulation. On the other hand, the reform’s effect has not been synchronized with the effect on the other-insuerd-region patients. There is a risk that hospitals will pass on the payment reform cost to the other-insuerd-region patients.