Unraveling the effects of DIP payment reform on inpatient healthcare: insights into impacts and challenges.

BACKGROUND: The Diagnosis-Intervention Packet (DIP) payment system, initiated by China's National Healthcare Security Administration, is designed to enhance healthcare efficiency and manage rising healthcare costs. This study aims to evaluate the impact of the DIP payment reform on inpatient care in a specialized obstetrics and gynecology hospital, with a focus on its implications for various patient groups. METHODS: To assess the DIP policy's effects, we employed the Difference-in-Differences (DID) approach. This method was used to analyze changes in total hospital costs and Length of Stay (LOS) across different patient groups, particularly within select DIP categories. The study involved a comprehensive examination of the DIP policy's influence pre- and post-implementation. RESULTS: Our findings indicate that the implementation of the DIP policy led to a significant increase in both total costs and LOS for the insured group relative to the self-paying group. The study further identified variations within DIP groups both before and after the reform. In-depth analysis of specific disease groups revealed that the insured group experienced notably higher total costs and LOS compared to the self-paying group. CONCLUSIONS: The DIP reform has led to several challenges, including upcoding and diagnostic ambiguity, because of the pursuit of higher reimbursements. These findings underscore the necessity for continuous improvement of the DIP payment system to effectively tackle these challenges and optimize healthcare delivery and cost management.

[Case-control study on long head of biceps tendon cut-off and re-fixation for the treatment of proximal humeral fractures].

OBJECTIVE: To investigate clinical effect of open reduction and internal fixation in treating proximal humeral fracture by using long head of biceps tendon cutted-off and re-fixation. METHODS: From January 2014 to January 2017, 50 patients with proximal humeral fractures were treated by open reduction and internal fixation. According to whether long head of biceps tendon cutted-off and re-fixation, patients were divided into control group and treatment group, 25 patients in each group. There were 13 males and 12 females with an average of (73.8±4.5) years old in control group, treated with conventional open reduction and internal fixation. There were 15 males and 10 females, with an average of (74.1±5.4) years old in treatment group, treated by using long head of biceps tendon cutted-off and re-fixation on the basis of control group. Fracture healing time and complications after operation were compared between two groups, VAS score was used to evaluate relieve degree of pain, and Neer functional score at 1, 3, 6, 12 months after operation was applied to access clinical efficacy. RESULTS: All patients were followed up for 12 to 24 months with an average of (14.5±3.6) months. There was no statistical difference in following-up between tow groups. Postoperative VAS score at 1 week between treatment group and control group were 2.92±1.10 and 5.88±0.90 respectively, and had significant difference(P<0.05). Postoperative Neer functional scores at 1 month between treatment group and control group were 77.88±5.70 and 73.68±4.90 respectively, while 85.88±5.30 and 79.88±3.90 respectively at 3 months after operation, and there were significant difference between two groups at 1 and 3 months after operation(P<0.05). There were no statistical differences in Neer functional score between two groups at 6 and 12 months after operation(P>0.05). According to postoperative Neer score at 12 months, 9 patients got excellent results, 14 moderate and 2 poor in treatment group; while 4 patients got excellent results, 18 moderate and 3 poor in control group; but there was no difference between two groups. Fracture were healed without postoperative complications between two groups. CONCLUSIONS: Open reduction internal fixation with in treating proximal humeral fracture by using long head of biceps tendon cutted-off and re-fixation could reduce pain, speed up early recovery of joint function, is worthy of further promotion.