Abstract
Background In 2023, an innovative case-based Diagnosis-Related Groups payment method was piloted in an economically underdeveloped city in Southwest China. This study aims to investigate the impact of this payment reform on the service capacity, cost, and efficiency of inpatient services in the Neurology Department of the leading hospital in the county-level medical community.
Methods This study included monthly data from January 2021 to June 2024 for inpatients in the Neurology Department of M Hospital in A City, Yunnan Province. Eleven outcome indicators were analyzed, including total DRGs weight, Case mix index, Average length of stay (days), and Average cost per inpatient stay (RMB). An interrupted time series model with a control group was used to examine the effects of the DRGs payment reform on these outcome indicators.
Results After the implementation of the DRGs reform in January 2023, the total DRGs weight of the Neurology Department increased by 26.81 (95% CI: 0.99 to 52.63, P < 0.05), and the CMI increased by 0.01 relative to other departments in the same hospital (95% CI: 0.00 to 0.17, P < 0.01). In terms of costs, the average length of stay decreased by 0.06 days (95% CI: -0.09 to -0.039, P< 0.01), the average cost per inpatient stay decreased by 45.55 RMB (95% CI: -72.92 to -18.17, P < 0.01), and the average medication cost per inpatient stay decreased by 12.29 RMB (95% CI: -23.50 to -1.08, P < 0.05).
Conclusions This study confirms that DRGs improve the inpatient service capacity of the neurology department and reduce inpatient costs. Given the limited medical resources in economically underdeveloped areas, actively promoting DRGs payment reform is imperative. Health insurance departments should promptly update and adjust DRGs coding schemes to incentivize high-level hospitals to admit patients with complex and difficult-to-treat conditions. Medical institutions should regularly assess the financial status of departments under the DRGs payment method, implement refined management practices, and provide individualized treatment plans that integrate traditional Chinese and Western medicine. This ensures the provision of high-quality, efficient inpatient services while maintaining a certain profit margin.