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ORIGINAL RESEARCH article

Front. Public Health
Sec. Health Economics
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1431991

How Significant Is Cost-shifting Behavior Under the Diagnosis Intervention Packet Payment Reform? Evidence from the Coronary Heart Disease Market

Provisionally accepted
Huawei Tan Huawei Tan Xueyu Zhang Xueyu Zhang Dandan Guo Dandan Guo Shengxian Bi Shengxian Bi Yingchun Chen Yingchun Chen *
  • Huazhong University of Science and Technology, Wuhan, China

The final, formatted version of the article will be published soon.

    Background: Controlling the growth of inpatient costs presents a major challenge in China's healthcare system. China introduced a new case-based payment method, the "Diagnosis Intervention Packet" (DIP), to address the surge in hospitalization expenses. However, the influence of DIP payment reform on cost shifting among coronary heart disease (CHD) inpatients remains unclear.Methods: This study focused on Zunyi, a national pilot city for DIP, utilizing inpatient claim data to assess the effects of DIP payment reform. We analyzed the influence on total health expenditures (THE), individual payments excluding reimbursement (IPER), proportion of IPER, copayments for category-B, proportion of copayments for category-B, copayments for category C, and proportion of copayments for category C per case for CHD inpatient .Results indicate a significant reduction in THE per case for CHD inpatients after the DIP reform (β=-0.1272, p<0.01). Increases in cost shifting were observed in IPER (β=0.1080, p<0.05), the proportion of IPER (β=0.0551, p<0.01), copayments for category B (β=0.2392, p<0.01), and the proportion of copayments for category B (β=0.0295, p<0.01), along with the proportion of copayments for category C (β=0.0255, p<0.01). However, the copayments for category C did not significantly change. Notable variations in the effects of cost control and shifting were observed across different hospital categories, teaching statuses, hospital grades, and ownership types.The DIP reform significantly reduced the THE per case for CHD inpatients, while shifting in-policy expenditures to IPER, particularly with a greater shift intensity in the proportion of Class B compared with the proportion of Class C.

    Keywords: Payment reform, Regional global budget, Diagnosis-intervention packet, hospital behaviour, CHD, Cost-containment, Cost-shifting, China

    Received: 13 May 2024; Accepted: 06 Nov 2024.

    Copyright: © 2024 Tan, Zhang, Guo, Bi and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yingchun Chen, Huazhong University of Science and Technology, Wuhan, China

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