Analysis of factors influencing changes in medical behavior under the context of DRG payment method reform: a structural equation modeling approach

Behavioral adaptations to DRG reform are driven primarily by cognitive evaluations (positive/negative policy perceptions), not mere policy knowledge. Contrary to expectations, deeper policy understanding correlates with increased negative medical behavior and reduced positive behavior, suggesting that technical training alone may inadvertently incentivize gaming under financial pressures. Positive cognition strongly promotes desirable behaviors, while negative cognition exacerbates detrimental practices. To optimize reform success, China must prioritize value-oriented training (emphasizing DRG's systemic goals over mechanics) and implement intelligent auditing mechanisms to curb high-risk behaviors during transition.