BACKGROUND

Since 2020, China has implemented a payment method known as "Diagnosis-Intervention Package" (DIP) in 71 cities nationwide to address the specific needs of the country. The objective of this study is to evaluate the impact of DIP on medical quality and the burden experienced by inpatients covered under the Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI). Furthermore, it aims to investigate potential differences in these effects between inpatients enrolled in the two distinct types of insurance, thereby enhancing our understanding of how this reform in payment methods influences healthcare delivery, and refine the social security system.

METHODS

We conducted a multiple-group interrupted time series analyses (MGITSA) on outcome variables reflecting medical services quality, and the burden of UEBMI and URRBMI inpatients, based on a dataset containing 180,071 inpatient reimbursement records in City C spanning from January, 2019 to December, 2021. This dataset included 42,581 records for URRBMI inpatients and 137,490 records for UEBMI inpatients.

RESULTS

After DIP implementation, both UEBMI and URRBMI showed increased inpatient numbers (21.59% and 22.26%, respectively), reduced LOS (7.10% for UEBMI, 0.29% for URRBMI), and higher ACR (3.07% for UEBMI, 15.36% for URRBMI). Hospitalization costs increased slightly for both groups (2.97% for UEBMI, 10.44% for URRBMI). Subgroup analysis revealed age-specific differences: significant LOS and cost changes in <18-year-olds and >45-year-olds, but minimal effects in 18-45-year-olds. MGITSA showed URRBMI experienced significant LOS reduction (β3=-0.004, P=0.014), while UEBMI had more pronounced LOS and ACR trends, with no significant inter-group differences in cost slopes.

CONCLUSION

DIP improved hospital efficiency (reduced LOS, increased admissions) and financial protection (higher ACR) for both insurance groups in the short term, though hospitalization costs rose, requiring attention to potential service intensity inflation or cost-shifting. Age disparities in DIP impacts highlight the need for targeted policies. Continuous monitoring and policy adjustments are essential to balance cost control, service quality, and equity, ensuring DIP's long-term effectiveness in China's healthcare reform.