Objective: The paper attempts to systematically evaluate the long-term impact of Diagnosis-Related Group (DRG) payment on hospitalization costs and individual financial burden for patients, thereby providing empirical evidence for refining China's medical insurance payment policies. Methods: Utilizing 10-year panel data (2015-2024) from before and after the DRG reform in a pilot city, we employed the interrupted time series (ITS) model to analyze trend changes in the following indicators: average cost per hospitalization, average out-of-pocket expense per hospitalization, and the cost structure (including average medication costs, average consumable costs, average examination costs, and average laboratory test costs). Results: The findings revealed that after DRG implementation, the average hospitalization cost per case showed a significant decreasing trend (P<0.05). However, the trend in average out-of-pocket expense per case was not statistically significant (P>0.05), with heterogeneous responses observed across different hospitals, particularly among specialized hospitals. The DRG reform significantly optimized the hospital cost structure, evidenced by a decline or a slowdown in the growth of medication, consumable, and laboratory test costs (P<0.05). Conversely, examination costs demonstrated an accelerating upward trend (P<0.05), indicating a structural substitution. Conclusion: The DRG payment system is effective in curbing the unreasonable growth of hospitalization costs and individual financial burdens for patients. Simultaneously, while DRG reform optimizes certain cost components, it may also trigger structural substitution and cost shifting among service items. Future policies should focus on strengthening the systemic coordination among medical insurance, healthcare, and pharmaceutical reforms, and gradually achieving an optimized cost structure.
Key words
diagnosis-related group payment /
hospitalization costs /
out-of-pocket payments /
cost structure /
interrupted time series analysis
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