The Evaluation Of The Cost Control Effect Of DIP Payment Reform On Primary Hospitals

Objective This study used a county hospital in Northwest China,as an illustration,to examine the hospitalization of inpatients and the trajectory of changes in hospitalization expenses before and after the implementation of the DiagnosisIntervention Packet(DIP)reform policy,to analyze the changes in hospitalization expenses and the internal component,to investigate the impact of the DIP reform on hospitalization expenses,and to evaluate the cost-controlling function of the DIP reform.Methods To understand inpatient hospitalization and the trend of changes in hospitalization expenses before and after the policy implementation,this study selected data about patients discharged from a county hospital in Northwest China from 2018 to2022.It then analyzed the total hospitalization expense and studied the internal composition and changes in hospitalization expense using the Degree of Structure Variation(DSV).The immediate changes and long-term trends in total hospitalization expenses and single expenses before and after the DIP policy’s introduction were examined using an Interrupted Time Series(ITS)model.An analysis and evaluation of the impact of the DIP reform policy on total hospitalization expenses and single expenses in the context of the current hospital operation following the implementation of DIP reform were conducted using the difference-in-difference(DID)method to compare the differences in inpatient costs with and without the DIP reform.Results(1)The total hospitalization expenses were consistently higher for female patients than for male patients,but their average hospitalization expenses per time and per case were lower than those for male patients from 2018 to 2021.The total hospitalization expenses and the length of hospital stay were generally declining.The average hospitalization expenses per time and per case for those aged 65 years old and over were higher than those for those aged 0-14 years old and 15-64 years old,with those aged 0-14 years old being the lowest.(2)Following implementation,the hospital’s enrollment rate to the DIP grouping database was 94.78%,with the core population of each department accounting for at least 87% of the total.The top five enrollment categories were,in descending order:general surgery,neurology,orthopedics,respiratory medicine,and other departments.The intensive care unit had the highest percentage of low-fold instances,which was triple the percentage of high multiples.In general surgery,the percentage of high multiples was the highest.(3)After the implementation,the average length of hospital stay was 7 days.The departments with an average length of hospital stay greater than 7 days included gynecology,orthopedics,geriatrics,neurology,and Chinese medicine,of which the average length of hospital stay in Chinese medicine was the longest at 11 days and the shortest was at 3 days in critical care departments.After the DIP reform,the hospital lost about 4 million in comparison to fee-for-service,with a loss per time of 144.53 yuan.General surgery had the most serious loss and cardiology had the highest profit;among the various departments,the highest service capacity was in orthopedics and general surgery,the fastest service efficiency was in critical care and general medicine,and the highest service contribution was in cardiology.(4)In the analysis of structural variation,except for drug expense and other expense which showed negative variation,all other single expenses showed positive variation;The most significant items affecting the structural variation of hospitalization expenses were the costs of drugs and comprehensive medical services,which together accounted for 83.91% of the structural variation with respective contributions of 54.88%and 29.03%;with structural variation contribution rates of 9.47%,8.89%,6.57%,0.23%,0.02%,and 0.01%,respectively,for the remaining components,which were diagnostic expenditures,treatment expenses,consumables expenses,miscellaneous expenses,and rehabilitation expenses,having a cumulative contribution rate of 16.09%.(5)There were no notable trend changes in hospitalization expenses,average hospitalization expenses per time,drug expenses,average drug expenses per time,or drug ratio during the 18 months before the reform,according to a comparison of expenses based on the ITS model.The immediate changes in the average hospitalization expense per time,average hospitalization expense per case,average drug expense per time,average drug expense per case,and drug ratio were more significant in the first month after the reform’s implementation and all showed a downward trend of variation(P< 0.001),by 1932.48 yuan/time,1,960.83 yuan/case,1.12 million,1128.13 yuan/time,1145.15 yuan/case and 11.69%,respectively.The average hospitalization expense per time,average hospitalization expense per case,average drug expense per time,average drug expense per case,and drug ratio all indicated an upward tendency when compared to the pre-reform period in terms of trend changes(P< 0.01).(6)Based on a single factor analysis,multiple linear regression models and random forest regression models were created for the total hospitalization expenses and each single expense,respectively.It was determined that the random forest prediction model should be used because the MSE,RMSE,and MAE of the multiple linear regression model were all higher than those of the random forest regression model.(7)In the DID method to compare the differences in each expense,the predicted expenses without DIP reform were used as the control group,and the actual expense was the experimental group.Hospitalization expenses decreased in the hospital that underwent reform,which showed significance at the 0.01 level(t=-3.609)on the policy dummy variable by the model for expenses.The DIP reform policy had a negative impact on hospitalization costs in the experimental group compared to the control group.In addition to the total hospitalization expenses,the expenses of diagnostics and drugs all showed a horizontal reduction.The expenses of comprehensive medical services,treatment,and consumables all had regression coefficients that were greater than zero and increased after the reform compared to the period without DIP reform.Conclusions(1)The DIP reform has had a major short-term influence on the cost control of primary hospitals in Northwest China at first,but it will be necessary to regularly monitor the long-term impact as the DIP payment reform is improved.(2)The internal structure of total hospital expenses has been enhanced,along with the expenses for comprehensive medical services and treatments that indicate the value of the technical services provided by medical staff.(3)The primary factor causing the structural variation in total hospitalization expenses and contributing the most to the variation was the expense of drugs.(4)The prefecture hospital has been very successful in cutting the expenses of drugs,but less successful in doing so for consumables.