DRG-based payment and governance in high-complexity thoracic surgery: implications for efficiency and care delivery
Li Ma1,2,3, Jianxiong Ma2, Xiaojing Yan2
1Department of Oncology, Beijing Chest Hospital, Capital Medical University, Beijing, China.
Frontiers in Health Services
|June 10, 2026
Summary
Diagnosis-related group (DRG) payments impact thoracic surgery by increasing efficiency and reducing costs. Operational variations and governance factors influence performance in high-acuity surgical settings under DRG constraints.
Area of Science:
- Healthcare Management
- Surgical Operations Research
- Health Economics
Background:
- Diagnosis-related group (DRG)-based prospective payment aims to enhance healthcare efficiency and cost control.
- The impact of DRG payments on high-complexity surgical services, such as thoracic surgery, requires further investigation.
- Thoracic surgery's complexity makes it a relevant model for studying DRG payment effects on clinical structure and operational performance.
Purpose of the Study:
- To analyze the operational and financial performance of thoracic surgery under DRG-based prospective payment.
- To examine variations in surgical volume, case complexity, length of stay, and resource consumption within and across DRG groups.
- To explore the influence of DRG classification and interdepartmental factors on performance outcomes.
Main Methods:
- Retrospective longitudinal study using DRG data from 2023-2025 in a tertiary hospital.
- Analysis of surgical volume, case-mix index (CMI), length of stay (LOS), and resource consumption indices.
- Interdepartmental comparisons within the EB19 DRG group and structural differences across DRG groups were evaluated.
Main Results:
- The EB19 DRG group represented 26.1% of thoracic admissions with a high CMI (4.02).
- Surgical volume increased in some units, while overall case complexity remained stable; mean LOS and resource consumption indices decreased.
- Significant interdepartmental variations in LOS, cost, and financial performance were observed within the EB19 group, despite identical DRG classification.
Conclusions:
- DRG-based payments may drive operational convergence and efficiency gains in thoracic surgery.
- Governance-related factors likely play a role in shaping unit performance under DRG constraints.
- Findings highlight the need for caution in interpreting results due to the descriptive nature and lack of patient-level clinical outcomes.
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