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ORIGINAL RESEARCH article

Front. Public Health
Sec. Health Economics
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1437272
This article is part of the Research Topic Healthcare Coverage and Payment Reforms in Low- and Middle-Income Countries View all 4 articles

DRG payment for major pancreatic surgery: Analysis of resource consumption and suggestions from a tertiary hospital in China

Provisionally accepted
Rui Hou Rui Hou 1xiaokun liu xiaokun liu 2*jingya zhou jingya zhou 2*taiping zhang taiping zhang 1*weibin wang weibin wang 1*weiguo zhu weiguo zhu 2*
  • 1 Department of General Surgery, Peking Union Medical College Hospital (CAMS), Beijing, Beijing Municipality, China
  • 2 Peking Union Medical College Hospital (CAMS), Beijing, Beijing Municipality, China

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

    Aim: To investigate the cost homogeneity within the Diagnosis-Related Group (DRG) "major operation of pancreas and liver, with general complications or comorbidities" (HB13), the cost-influencing factors, and to propose suggestions for better grouping efficacy. Methods:Medical and insurance settlement data of inpatients covered by the DRG payment system at the author's institution were collected from March 15, 2022 to December 31, 2023. The cost homogeneity of group HB13 was assessed using the coefficient of variation (CV). Clinical factors that may have an impact on hospitalization cost for patients undergoing pancreatic surgery were identified through a semi-structured interview administered to the pancreatic surgeons in author's department, their significance was analyzed using multiple linear regression and t-tests, along with their impact on the cost of different service categories. Results: The CV of the HB13 group was 0.4. Robotic-assisted surgery and pancreaticoduodenectomy were two independent factors that significantly affected the total cost. Patients undergoing robotic-assisted surgery have an average increase of 41873 CNY in total cost, primarily derived from operation fee. Patients undergoing pancreaticoduodenectomy have an average increase of 37487 CNY in total cost, with significant increases across all service categories. Conclusion: The cost homogeneity of HB13 was lower than that of other DRG groups in author's department. It is recommended to introduce a supplementary payment for patients requiring robotic-assisted surgery, to guarantee their access to this advanced technology. It is recommended to establish a new group with higher payment standard for patients undergoing pancreaticoduodenectomy. A tiered CV criterion for the evaluation of grouping effectiveness is recommended to increase intra-group homogeneity, facilitating a better utilization and allocation of health insurance funds, and the prevention of unintended negative outcomes such as service cuts and cherry-picking.

    Keywords: DRG, pancreatic surgerypanc, reaticoduodenectomy, Robotic-assisted surgery, Coefficient of variation (CV)

    Received: 23 May 2024; Accepted: 04 Sep 2024.

    Copyright: © 2024 Hou, liu, zhou, zhang, wang and zhu. 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:
    xiaokun liu, Peking Union Medical College Hospital (CAMS), Beijing, 100730, Beijing Municipality, China
    jingya zhou, Peking Union Medical College Hospital (CAMS), Beijing, 100730, Beijing Municipality, China
    taiping zhang, Department of General Surgery, Peking Union Medical College Hospital (CAMS), Beijing, 100730, Beijing Municipality, China
    weibin wang, Department of General Surgery, Peking Union Medical College Hospital (CAMS), Beijing, 100730, Beijing Municipality, China
    weiguo zhu, Peking Union Medical College Hospital (CAMS), Beijing, 100730, Beijing Municipality, China

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