DRG Practice and Application
Changes of hospitalization days and costs for lung cancer surgery patients under DRG payment reform
Gao Tianfu, Wang Hongtao, Chen Binbin
Published 2024-03-02
Cite as Chin J Hosp Admin, 2024, 40(3): 201-206. DOI: 10.3760/cma.j.cn111325-20230915-00160
Abstract
ObjectiveTo evaluate the impact of diagnosis-related group (DRG) payment reform on the hospitalization days, costs, and incidence of surgical complications of lung cancer surgery patients in a certain specialized hospital, so as to provide references for improving the medical insurance payment methods in China.
MethodsThe data of lung cancer surgery patients′ medical records were extracted from the electronic medical record system of a tumor specialized hospital in Tianjin City from October 2021 to November 2022. In November 2021, the hospital launched DRG reform. Non-basic medical insurance patients in Tianjin were selected as the control group, while patients with basic medical insurance in Tianjin were selected as the research group. Patients were divided into the control group before DRG reform, the research group before DRG reform, the control group after DRG reform, and the research group after DRG reform. The propensity score matching was used to control the demographic characteristics of patients in each group, and the different-in-difference model (DID) was used to analyze the impact of DRG reform on the hospitalization days, costs and incidence rate of surgical complications of lung cancer patients.
ResultsA total of 7 689 lung cancer surgical patients were included. After propensity score matching, there were 361 cases in the control group before DRG reform, 364 cases in the research group before DRG reform, 361 cases in the control group after DRG reform, and 364 cases in the research group after DRG reform. According to the DID analysis, compared with before the DRG reform, the hospitalization days and costs of lung cancer patients decreased by 11.3% and 4.8% after the DRG reform, respectively, with statistically significant differences (P<0.05); Among them, the examination cost and consumables cost in the hospitalization costs decreased by 7.1% and 10.0% respectively, with statistical significance (P<0.05), but the changes in surgical cost, treatment cost, and drug cost were not significant (P>0.05), as while as the incidence rate of complications (P>0.05).
ConclusionsThe reform of DRG payment could reduce the hospitalization days and costs for lung cancer surgical patients, and ensure the quality of medical care for patients. However, the optimization effect on the hospitalization cost structure needed to be strengthened.
Key words:
Diagnosis-related groups; Payment reform; Lung cancer; Propensity score matching; Difference-in-difference model; Medical insurance
Contributor Information
Gao Tianfu
Medical Record Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin′s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
Wang Hongtao
Medical Record Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin′s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
Chen Binbin
Beijing Medical and Health Economic Research Association, Beijing 100101, China
