Presentation (CTI)

OBJECTIVES: To evaluate the operational effects of a uniform payment policy for selected diagnosis-related groups (DRGs) in City A, China, under which comparable inpatient cases were reimbursed at the same or nearly the same rate across hospital levels. The study assessed whether this policy reduced resource use, promoted inter-hospital cost convergence, altered the distribution of cases across hospital tiers, and improved payment adequacy.
METHODS: We analyzed 2024-2025 inpatient health insurance settlement data, DRG catalogues, and hospital-level information. DRG-paid cases were classified as municipal basic DRGs, county-level primary-care DRGs, or regular DRGs according to annual policy definitions and provider level. Descriptive analyses compared DRG composition, case share, length of stay, hospitalization costs, patient payments, resource consumption indices, inter-hospital cost variation, and estimated differences between DRG payment standards and actual costs.
RESULTS: Municipal basic DRGs covered a broader set of conditions, whereas county-level primary-care DRGs were more concentrated in medical and low-weight groups. From 2024 to 2025, the share of municipal basic-DRG cases increased from 10.4% to 17.3%, and county-level primary-care cases from 2.9% to 4.4%. Both policy groups showed reductions in length of stay, hospitalization costs, and resource consumption indices. However, case redistribution across hospital levels was limited: municipal basic-DRG cases remained concentrated in tertiary hospitals, and county-level primary-care cases were mainly treated by county secondary hospitals. Cost variation across hospitals was lower in both policy groups than in regular DRGs, but tertiary hospitals continued to face estimated deficits for municipal basic DRGs.
CONCLUSIONS: Uniform DRG payment was associated with cost convergence and reduced resource use, but did not substantially redirect care to lower-level providers. Payment reform should be combined with dynamic DRG selection, payment calibration, referral coordination, provider capacity building, and quality monitoring.