The impact of DRG payment reform on stroke inpatient costs: a propensity score matching and difference-in-differences analysis of a large public hospital in Northeast China

The advancement of China’s Diagnosis Related Groups (DRG) payment reform represents a crucial measure to deepen the healthcare system reform, address the persistent rise in medical costs, and counter the imbalance between medical insurance fund revenues and expenditures. This study aims to evaluate the impact of the DRG payment policy on hospitalization costs for stroke patients. Medical records of stroke patients discharged from a large public hospital in Northeast China between September 2018 and December 2024 were collected. Propensity Score Matching (PSM) and Difference-in-Differences (DID) models were employed to analyze the impact of DRG payment on stroke patients’ length of stay (LOS), cost structure, and out-of-pocket (OOP) expenditure share. After the implementation of DRG payment, the total hospitalization costs for stroke patients decreased by 19.31%. While treatment costs showed minimal change, all other individual cost items experienced significant reductions, with the largest declines observed in Western medicine costs (23.11%) and consumable costs (32.21%). The LOS and OOP expenditure proportions decreased by 8.90% and 2.83%, respectively. Heterogeneity analysis indicates that DRG payment reduced hospitalization costs by 18.48% for elderly patients, 22.68% for non-elderly patients, 21.97% for male patients, and 15.94% for female patients. The DRG payment plays a vital role in optimizing the structure of hospitalization costs and controlling unreasonable cost growth.However, further efforts are needed, including deepening salary system reforms, strengthening the development of DRG information platforms, refining basic medical insurance, and providing medical assistance for low-income populations. Special attention should be given to vulnerable groups such as the elderly and women, with improved green channels and enhanced humanistic care.