Scholarlink

Background <p>As China transitions from fee-for-service (FFS) to case-based payment systems, the Diagnosis-Intervention Packet (DIP) system has emerged as a key approach to enhance cost containment and service efficiency. Aligning internal incentives, such as through performance-based pay schemes (PBPS), is crucial to fully realizing the intended effects of DIP.</p> Methods <p>This study assessed the impact of implementing a DIP-aligned PBPS reform on hospital revenue structure and service efficiency. Using administrative data from a pilot city, we conducted controlled interrupted time series analyses, comparing public hospitals that adopted the DIP-aligned PBPS with those that retained the traditional PBPS, stratified by insurance type: Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI).</p> Results <p>After the reform, the intervention group showed a significant monthly decline in the proportion of drug sales in inpatient expenses (− 0.76%, <i>P</i> = 0.046), particularly among UEBMI patients (− 0.875%, <i>P</i> = 0.035), with no significant change for URBMI. The proportion of laboratory tests and examinations in inpatient expenses dropped immediately in the overall sample (− 3.479%, <i>P</i> = 0.006), UEBMI (− 4.246%, <i>P</i> = 0.006), and URBMI (− 2.922%, <i>P</i> = 0.025), but subsequently showed upward monthly trends (overall: 0.495%, <i>P</i> = 0.009; UEBMI: 0.503%, <i>P</i> = 0.014; URBMI: 0.461%, <i>P</i> = 0.016). The cost consumption index declined steadily over time (overall: −0.026, <i>P</i> = 0.025; UEBMI: −0.026, <i>P</i> = 0.040; URBMI: −0.026, <i>P</i> = 0.027), as did the time consumption index (overall: −0.012, <i>P</i> = 0.032; UEBMI: −0.015, <i>P</i> = 0.036; URBMI: −0.011, <i>P</i> = 0.045).</p> Conclusion <p>Integrating PBPS reform with DIP payment implementation effectively reduced drug expenditures and enhanced service efficiency in public hospitals. However, the observed differences between the UEBMI and URBMI groups raise essential concerns about equity in health service delivery, and the increase in expenses for laboratory tests and examinations suggests potential gaming behavior in response to new incentives. These findings underscore the need for continuous policy monitoring and adaptive regulation to mitigate unintended effects and ensure the success of PBPS reforms.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

The impact of public hospital performance-based pay scheme reform on revenue structure and service efficiency under the Diagnosis-Intervention Packet payment system: evidence from a pilot city in China

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年3月28日

查看全文
  • Huanyu Shi,
  • Baoli Su,
  • Kun Wang,
  • Dian Zhang,
  • Zhichao Liu,
  • Yang Zhang,
  • Zhichao Cheng

摘要

Background

As China transitions from fee-for-service (FFS) to case-based payment systems, the Diagnosis-Intervention Packet (DIP) system has emerged as a key approach to enhance cost containment and service efficiency. Aligning internal incentives, such as through performance-based pay schemes (PBPS), is crucial to fully realizing the intended effects of DIP.

Methods

This study assessed the impact of implementing a DIP-aligned PBPS reform on hospital revenue structure and service efficiency. Using administrative data from a pilot city, we conducted controlled interrupted time series analyses, comparing public hospitals that adopted the DIP-aligned PBPS with those that retained the traditional PBPS, stratified by insurance type: Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI).

Results

After the reform, the intervention group showed a significant monthly decline in the proportion of drug sales in inpatient expenses (− 0.76%, P = 0.046), particularly among UEBMI patients (− 0.875%, P = 0.035), with no significant change for URBMI. The proportion of laboratory tests and examinations in inpatient expenses dropped immediately in the overall sample (− 3.479%, P = 0.006), UEBMI (− 4.246%, P = 0.006), and URBMI (− 2.922%, P = 0.025), but subsequently showed upward monthly trends (overall: 0.495%, P = 0.009; UEBMI: 0.503%, P = 0.014; URBMI: 0.461%, P = 0.016). The cost consumption index declined steadily over time (overall: −0.026, P = 0.025; UEBMI: −0.026, P = 0.040; URBMI: −0.026, P = 0.027), as did the time consumption index (overall: −0.012, P = 0.032; UEBMI: −0.015, P = 0.036; URBMI: −0.011, P = 0.045).

Conclusion

Integrating PBPS reform with DIP payment implementation effectively reduced drug expenditures and enhanced service efficiency in public hospitals. However, the observed differences between the UEBMI and URBMI groups raise essential concerns about equity in health service delivery, and the increase in expenses for laboratory tests and examinations suggests potential gaming behavior in response to new incentives. These findings underscore the need for continuous policy monitoring and adaptive regulation to mitigate unintended effects and ensure the success of PBPS reforms.