An expert narrative review on the impact of DRG/DIP payment reforms on hospital lean operations and cost performance management

• Overarching Findings • DRG/DIP payment reforms transition hospitals from volume-driven “revenue centers” to value-based “cost centers,” enhancing cost containment and operational efficiency by approximately 37%. • Despite significant heterogeneity (I² > 50%) across 49 included studies, consistent improvements in resource utilization and process optimization were observed, particularly in tertiary hospitals. • Mechanistic Insights • The shift to fixed-case payments under DRG/DIP creates dual pressures for cost control and quality maintenance, often leading to potential cost-shifting risks (e.g., increased out-of-pocket expenses). • Integration of clinical pathways with activity-based costing enables precise cost tracking and standardization, reducing waste while preserving care quality. • Methodological Rigor and Synthesis • A structured narrative synthesis was employed due to substantial methodological heterogeneity. Sensitivity analyses confirmed the robustness of primary findings, with effect estimates varying by <5% after excluding high-bias studies. • Innovative Frameworks Introduced • The Precision-Experience-Learning (PEL) Synergy Model integrates precision metrics, experiential data, and continuous learning to optimize lean operations under DRG/DIP constraints. • A multi-technical convergence framework combining time-spatial costing, AI-driven decision support, and reinforcement learning algorithms demonstrated 23% superior performance in resource allocation simulations. • Practical and Policy Implications • Successful implementation requires clinician-administrator collaboration, advanced health information systems, and adaptive incentive mechanisms. • Policymakers are advised to adopt phased reforms supported by real-time quality monitoring, especially in settings with fragmented payment structures. : Diagnosis-Related Groups (DRG) and Diagnosis-Intervention Packet (DIP) payment reforms are critically reshaping hospital operational models by transitioning from volume-driven to value-based care. However,significant evidence gaps persist in balancing cost control with medical quality under resource constraints . : We evaluated the effectiveness of DRG/DIP payment reforms compared to traditional fee-for-service models in improving cost performance and operational efficiency for hospitals and healthcare systems. : We systematically searched PubMed, Cochrane Library,Embase,Web of Science,and ClinicalTrials.gov for studies published between 2020 and 2025. Our inclusion criteria encompassed randomized trials and cohort studies investigating collaborative governance or lean management frameworks. Two reviewers independently screened records using PRISMA guidelines. Due to substantial methodological heterogeneity (I²> 50%), we employed narrative synthesis rather than meta-analysis. : Our analysis included 49 studies (n = 15,392 participants). DRG/DIP implementations improved cost containment and process efficiency, with approximately 37% enhancement in resource utilization metrics. These findings demonstrate consistent improvements across diverse healthcare settings, although substantial heterogeneity precluded quantitative pooling. : DRG/DIP payment reforms show significant potential for enhancing hospital lean operations and cost performance. Consequently,future research should prioritize standardized metrics and robust evaluations to bridge policy-clinical gaps.