The impact of DRG on resource consumption of inpatient with ischemic stroke
Anle Wei1, Jianing Ren1, Wen Feng1
1Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
Insights
Diagnosis-related group (DRG) payment reform reduced length of stay for ischemic stroke patients. While DRG payments control costs for complex cases, they may not curb overall medical expense increases.
Area of Science:
- Health economics
- Healthcare management
- Stroke research
Background:
- Ischemic stroke presents a significant public health burden.
- Diagnosis-related group (DRG) payment reform was implemented in 12 public hospitals in L city.
- The study investigates the impact of this reform on inpatient resource utilization for ischemic stroke.
Purpose of the Study:
- To assess the effect of DRG payment reform on length of stay (LOS) and medical costs for ischemic stroke patients.
- To analyze changes in resource utilization across different patient subgroups.
Main Methods:
- Utilized interrupted time series analysis on data from the DRG local database.
- Examined changes in LOS and medical costs before and after the DRG reform.
- Subgroup analyses included hospital level, gender, age, and disease severity (e.g., MCC patients).
Main Results:
- Overall LOS decreased in both tertiary and secondary hospitals post-reform.
- Medical expenses decreased in tertiary hospitals but increased in secondary hospitals.
- Significant variations in LOS and cost changes were observed across different patient demographics and disease severities, with older patients and MCC patients showing notable shifts.
Conclusions:
- DRG payment reform effectively reduced LOS, potentially saving bed resources.
- The reform shows promise in controlling medical expenses for complex cases (ultra-high DRGs).
- However, DRG reform may not be sufficient to control the overall escalation of medical expenses.
Background:
Diagnosis-related group (DRG) payments were gradually introduced and used in 12 public hospitals in L city. Given the high incidence and burden of ischemic stroke, the study aimed to assess the impact of DRG payment reform on inpatient medical resource utilization.
Methods:
Data were obtained from the DRG local database of the new Chinese cooperative medical program in L city. The study used interrupted time series analysis to examine changes in length of stay and medical costs before and after the reform, and also assessed changes in different subgroups.
Results:
There were 763 and 4,731 ischemic stroke patients in tertiary hospitals and 1953 and 10,439 patients in secondary hospitals before and after the DRG payment reform, respectively. After the reform, LOS was reduced 0.047 and 0.47 days in tertiary and secondary hospitals, respectively. Medical expenses decreased by 30.189 yuan in tertiary hospitals, but those increased by 44.918 yuan in secondary hospitals monthly. For gender, the average LOS reduced by 0.462 and 0.471 days for male and female in secondary hospitals. The change in medical expenses for male patients in tertiary hospitals and female in secondary hospitals were more significant, with a decrease of 65.396 yuan and increase of 56.257 yuan. The most pronounced change in resource consumption was seen for patients aged 85 years and older, with an increase in average LOS and medical expenses by 0.394 days and 382.422 yuan in tertiary hospitals. They showed a reduction in the average LOS by 1.480 days, and increase in the average medical expenses by 133.485 yuan in secondary hospitals monthly. Regarding disease severity, the most significant changes were seen in MCC patients. The average LOS decreased by 0.197 and 0.928 days and the average medical expenses decreased by 131.526 and 21.631 yuan in tertiary and secondary hospitals, respectively.
Conclusion:
The implementation of DRG payment system has led to a reduction in the LOS in various levels of hospitals, which would save in bed resources. However, DRG payment reform can help to control medical expenses for ultra-high cases, but it may not be useful to control the overall increase in medical expenses.
Related Concept Videos
01:15Ischemic Stroke l: Introduction
01:15Ischemic Stroke ll: Pathophysiology