A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system

Wei-Fu Chang; Xin-Yu Yan; Hao Ling; Ting Liu; Ai-Jing Luo

doi:10.3389/fpubh.2023.1141981

A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system

Front Public Health. 2023 Jun 27:11:1141981. doi: 10.3389/fpubh.2023.1141981. eCollection 2023.

Authors

Wei-Fu Chang^{1

2

3}, Xin-Yu Yan^{3

4}, Hao Ling¹, Ting Liu⁵, Ai-Jing Luo^{6

7}

Affiliations

¹ Department of Medical Administration, The Third Xiangya Hospital of Central South University, Changsha, China.
² Xiangya School of Public Health, Central South University, Changsha, China.
³ Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China.
⁴ School of Life Sciences, Central South University, Changsha, China.
⁵ School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
⁶ Information Network Center, The Second Xiangya Hospital of Central South University, Changsha, China.
⁷ Clinical Research Center for Cardiovascular Intelligent Healthcare in Hunan Province, Changsha, China.

Abstract

Introduction: In recent years, China has implemented the Diagnosis Related Groups (DRG) payment system as part of its healthcare insurance reimbursement policy. Numerous studies have focused on the effectiveness of DRG payment system in controlling unreasonable growth in medical expenses. However, there has been no systematic report on the types of unintended behaviors exhibited by doctors under the DRG payment system.

Methods: The study first utilized interrupted time series analysis to analyze medical records and insurance data from eight hospitals. It investigated the data changes in MDC and ADRG groups before and after the implementation of the DRG payment system. Subsequently, a semi-structured interview method was employed to conduct qualitative research on the unintended behaviors of physicians, aiming to gain a more accurate understanding of specific changes in physician behavior after the implementation of the DRG payment system.

Results: This study discovered that doctors engage in unintended behaviors within the framework of the DRG payment system.

Discussion: In the early implementation of the DRG payment system in China, the contradictions between the flawed DRG payment methods and supporting systems and the actual diagnostic and treatment work manifested in the form of unintended doctor behaviors. Most of these unintended behaviors can be considered reasonable feedback from doctors to cope with the existing system flaws. They are conducive to identifying the deficiencies in China's DRG payment system and suggesting directions for improvement.

Keywords: DRG payment; interrupted time series analysis; negotiation mechanism; physicians; unintended behaviors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

China
Diagnosis-Related Groups*
Health Policy
Hospitals, Public
Humans
Physicians*

Grants and funding

This study was supported by the Natural Science Foundation of the Science and Hunan Provincial Science and Technology Department, China (Grant No. 2022JJ40734) and the Scientific Research Project of the Education Department of Hunan Province, China (Grant No. 20K138).