Wang Zhenguo, Li Li, Cui Yuwen
Nanshan People's Hospital, Jinan, Shandong Province, China.
School of Public Health, Shandong University, Jinan, Shandong Province, China.
Front Public Health. 2025 Apr 28;13:1532622. doi: 10.3389/fpubh.2025.1532622. eCollection 2025.
As one of the effective strategies adopted by countries worldwide to mitigate the rapid growth of healthcare expenditures, the DRG (Diagnosis-Related Group) payment system has been implemented in developed Western countries for both outpatient and inpatient care, focusing on costs associated with medical technologies, ancillary services, nursing care, and other healthcare-related expenses. However, in China, the excessive rise in consumable medical costs, particularly for pharmaceuticals, remains a primary driver of unreasonable healthcare expenditure growth. This study takes a healthcare alliance in City J, China, encompassing primary, secondary, and tertiary public hospitals, as a case example. By combining qualitative interviews with quantitative research methods, it explores the impact of DRG payment on physician prescribing behaviors. The results indicate that the DRG payment system significantly influences physician prescribing practices, a finding that holds after a series of robustness checks. Moreover, the effect varies across hospitals of different levels, with the DRG payment system having a more pronounced impact on pharmaceutical costs for acute ischemic stroke cases with two or fewer comorbidities. Therefore, the DRG payment system holds significant implications for the rational allocation of healthcare resources in China.
作为世界各国为缓解医疗保健支出快速增长而采取的有效策略之一，疾病诊断相关分组（DRG）支付系统已在西方发达国家用于门诊和住院护理，重点关注与医疗技术、辅助服务、护理及其他医疗相关费用相关的成本。然而，在中国，医用耗材成本的过度上涨，尤其是药品成本，仍然是不合理医疗支出增长的主要驱动因素。本研究以中国J市的一个医疗联盟为例，该联盟涵盖了一级、二级和三级公立医院。通过将定性访谈与定量研究方法相结合，探讨了DRG支付对医生处方行为的影响。结果表明，DRG支付系统对医生的处方行为有显著影响，这一发现经过一系列稳健性检验后依然成立。此外，不同级别医院的影响有所不同，DRG支付系统对合并症为两种及以下的急性缺血性中风病例的药品成本影响更为显著。因此，DRG支付系统对中国医疗资源的合理配置具有重要意义。
