Diagnosis-Related group payment and its impact on hospitalization costs and patient financial protection for neurointerventional stroke care in a Chinese tertiary hospital: a retrospective analysis

BACKGROUND: Stroke continues to impose a substantial economic burden globally. To mitigate escalating healthcare costs and enhance financial protection for patients, diagnosis-related group (DRG) payment systems have been widely implemented in China. Neurointerventional stroke care, characterized by its complexity and high costs, represents a critical area for evaluating the impact of such payment reforms. This study investigates the effects of the DRG payment system on hospitalization costs and patient out-of-pocket expenditures (OOPE) for neurointerventional stroke patients in a leading neurological hospital in China. METHODS: We conducted a retrospective cohort study using 2024 administrative data from Beijing Tiantan Hospital, China. The study included 5,205 inpatient stroke patients who underwent neurointerventional procedures (BE2 codes). Patients were categorized into a DRG payment group (Beijing residents, 18.87%) and a Fee-For-Service (FFS) payment group (non-Beijing residents, 81.13%) based on their medical insurance payment method. Pearson χ² tests and Mann-Whitney U tests were employed to compare total direct hospitalization costs (TDHC) and OOPE between the two groups. Quantile regression analysis further explored the impact of DRG payment across different expenditure levels to assess the heterogeneity of its financial protective effects. RESULTS: Compared to the FFS group, patients in the DRG payment group demonstrated significantly lower median TDHC (RMB 86,268 vs. RMB 102,885; p < 0.001), representing a 16.15% reduction. Similarly, the median OOPE for DRG patients was significantly lower (RMB 19,851 vs. RMB 30,266; p < 0.001), a 34.41% reduction. Quantile regression analysis confirmed consistent cost reductions across all expenditure quantiles (TDHC: 3.84%-5.16%; OOPE: 14.49%-36.32%), with more pronounced financial protection for patients with higher OOPE levels. Notably, centrally procured medical supplies were associated with increased costs, while higher insurance reimbursement, non-centrally procured medications, ICU transfers, and prolonged length of stay independently predicted higher expenditures. CONCLUSIONS: This single-center study demonstrates a significant association between the DRG payment system and effective cost containment and enhanced patient financial protection for neurointerventional stroke care in a large Chinese neurological center. These findings underscore the necessity for future DRG payment policy development to include specialty-adjusted DRG weights and to ensure coordinated integration between payment reforms and medical supply procurement policies. Due to its single-center nature and reliance on single-year data, caution is warranted when generalizing these results to other institutions and policy contexts.