2026-10-12T16:12:24Z https://api.figshare.com/v2/oai

oai:figshare.com:article/33870733 2026-09-17T04:28:17Z category_427 portal_316 item_type_3 month_year_09_2026

Table 1_Association of DRG-based payment reform with inpatient costs and resource use among older adults: an interrupted time series study in a county-level referral hospital in China.docx Jiacheng Zou (5548061) Shumin Wang (402967) Jiali Shi (11175186) Jianhan Chen (188309) Qing Guan (172034) Shaohua Li (334567) Public Health and Health Services not elsewhere classified China DRG-based payment inpatient costs interrupted time series older adults Background<p>China has rapidly expanded its diagnosis-related group (DRG)-based payment reform; however, evidence primarily focuses on urban pilots or specific disease cohorts. There is limited understanding of how DRG implementation affects out-of-pocket (OOP) spending, cost composition, and resource utilization among older adults treated in county-level referral hospitals.</p>Methods<p>We conducted a retrospective interrupted time series study utilizing administrative inpatient data from a tertiary county-level referral hospital in eastern China. From July 1, 2021, to July 31, 2025, we identified 154,744 admissions among adults aged ≥60. The outcomes assessed included total costs, out-of-pocket costs, drug costs, material costs, examination/laboratory costs, and length of stay (LOS). The primary analysis used admission-level segmented regression with standard errors clustered by calendar month. Supplementary analyses used monthly aggregated models with Newey-West standard errors and exploratory disease-group heterogeneity analyses.</p>Results<p>In the adjusted admission-level interrupted time series models, the implementation of DRG was associated with an immediate reduction in OOP costs (β₂ = −1360.617 CNY) and a more pronounced negative trend post-implementation (β₃ = −106.705 CNY per month). LOS experienced an immediate increase (β₂ = 0.831 days) and continued to rise in comparison to the pre-implementation trend (β₃ = 0.077 days per month). Total-cost findings differed by the analytical level: no statistically significant immediate or slope change was observed in the admission-level model (β₂ = −84.683 CNY; β₃ = 34.844 CNY/month), whereas the monthly aggregated model showed an immediate decrease (β₂ = −851.064 CNY) followed by an upward post-intervention slope change (β₃ = 75.090 CNY/month). Changes in total costs and most cost components were not consistent across different model specifications. Monthly aggregated analyses indicated directionally similar results for OOP costs and LOS. Disease-group analyses revealed that reductions in OOP costs were more substantial for neoplasms, digestive diseases, and circulatory diseases, while increases in LOS were primarily observed in certain circulatory and respiratory conditions.</p>Conclusion<p>Among older adult inpatients in a county-level referral hospital in China, DRG-based payment reform was associated with lower patient OOP but longer hospital stays. Its effects on total spending and cost composition were less consistent and varied across disease groups.</p> 2026-09-17T04:28:17Z Dataset Dataset 10.3389/fpubh.2026.1953054.s001 https://figshare.com/articles/dataset/Table_1_Association_of_DRG-based_payment_reform_with_inpatient_costs_and_resource_use_among_older_adults_an_interrupted_time_series_study_in_a_county-level_referral_hospital_in_China_docx/33870733 CC BY 4.0