The impact of DRG/DIP payment reform on medical behavior

Objective: This study aims to analyze the structural changes in various medical expenses incurred by hospital patients before and after the implementation of the DRG/DIP payment reform, indirectly examining alterations in physicians' medical practices while providing policy recommendations. Methods: Data from 198,423 patients treated at the Second Affiliated Hospital of Chengdu Medical College 416 Hospital of Nuclear Industry between January 1, 2019, and May 30, 2024 were collected. Descriptive statistics and comparative analysis methods were employed to categorize data pre- and post-DRG/DIP implementation, with a focus on comparison and structural analysis across major disease groups and departments. Results: Significant changes were observed in patient medical expense characteristics before and after the DRG/DIP payment reform. Post-reform, the average cost per patient was RMB 15,085.96—a decrease of RMB 1,173.18 (7.77%) compared to pre-reform levels. The expenditure on medications decreased by 18.12%, while laboratory test costs fell by 14.89%; conversely, expenditures for medical services exhibited relatively minor fluctuations. Among the top 35 DRG groups representing nearly half of the patient population, an impressive total of 29 groups experienced reductions in average total costs per episode. Conclusion: The reform in medical insurance payments is instrumental in curbing unreasonable increases in healthcare expenses; it is essential to optimize additional settlement mechanisms for special cases and new technologies to foster discipline development; enhance the quality of medical records alongside strengthening clinical pathway management; actively adapt to payment reforms; and refine internal hospital management practices to ensure fair compensation for healthcare professionals.