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.
Background:
Diagnosis-related group (DRG)-based prospective payment is intended to improve efficiency and control healthcare costs, but its impact on high-complexity surgical services remains uncertain. Thoracic surgery, characterized by a high proportion of complex procedures, provides a useful setting to examine how clinical structure and operational performance evolve under DRG constraints.
Methods:
A retrospective longitudinal study was conducted using DRG data from 2023 to 2025 in a tertiary hospital. Indicators included surgical volume, case-mix index (CMI), length of stay (LOS), and resource consumption indices. Interdepartmental comparisons were performed within the homogeneous DRG group EB19, and structural differences across DRG groups were evaluated. All analyses were conducted for descriptive and exploratory purposes.
Results:
EB19 accounted for 26.1% of thoracic admissions and showed a high DRG-specific CMI (4.02). Surgical volume increased in two units over the study period, while overall case complexity remained stable, indicating no apparent evidence of case-mix dilution at the aggregated level. Mean LOS declined across units, accompanied by reductions in resource consumption indices; for example, the cost consumption index in one unit decreased from 1.52 in 2023 to 0.97 in 2025. Within the EB19 group, substantial interdepartmental variation was observed despite identical DRG classification, with differences in LOS, cost, and financial performance across units. In addition, different DRG groups contributed differently to financial outcomes. The transition from RE16 (2023-2024) to RN16 and RN18 (2025) coincided with more homogeneous grouping and more interpretable performance patterns.
Conclusions:
The findings describe patterns of operational variation and convergence across units, suggesting the potential role of governance-related factors in shaping performance under DRG-based payment, with implications for understanding efficiency and care delivery in high-acuity surgical settings. Given the descriptive nature of the study and the absence of patient-level clinical outcomes, the findings should be interpreted with appropriate caution.
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