The Impact of DRG Reform on the Expenditure of Employees' Basic Medical Insurance Funds

doi:10.19546/j.issn.1674-3830.2026.4.008

China Health Insurance ›› 2026, Vol. 0 ›› Issue (4) : 75-84. DOI: 10.19546/j.issn.1674-3830.2026.4.008

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The Impact of DRG Reform on the Expenditure of Employees' Basic Medical Insurance Funds

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Abstract

Objective:The paper attempts to evaluate the impact of the DRG payment reform on the expenditure of the employees’ medical insurance fund, and to provide empirical evidence for alleviating the pressure on the balance of the fund. Methods:Based on the panel data of 282 prefecture-level cities in China from 2015 to 2023, a multi-period difference-in-differences (DID) method was adopted, combined with parallel trend tests, placebo tests, PSM-DID, Bacon decomposition, CSDID and other multi-dimensional robustness tests to systematically analyze the impact of DRG reform on the expenditure of the medical insurance fund. Results:DRG reform significantly affected the expenditure levels of the employees’ medical insurance fund—a finding contrary to the intuition of cost containment —suggesting the release of medical demand and institutional adaptation costs during the early phase of the reform. The number of health technicians per thousand people had a significant positive impact on the fund's expenditure, while the number of hospital beds per thousand people had no significant effect, indicating that human resources are more policy-sensitive than material resources. The reform effect was more prominent in eastern regions and central cities, while the effect in central and western regions and non-central cities was not obvious. Conclusion:DRG reform has improved the operational performance of the medical insurance fund, but the short-term expenditure expansion effect of this reform needs to be taken seriously. A linkage mechanism for fund income and expenditure should be established, regional differentiated strategies should be implemented, and a reform orientation prioritizing human resources should be established to ensure the sustainability of the medical insurance fund.

Key words

DRG / medical insurance payment method reform / multiple-period DID / employees’ medical insurance fund

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The Impact of DRG Reform on the Expenditure of Employees' Basic Medical Insurance Funds[J]. China Health Insurance. 2026, 0(4): 75-84 https://doi.org/10.19546/j.issn.1674-3830.2026.4.008

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