How do inpatients' costs, length of stay, and quality of care vary across age groups after a new case-based payment reform in China? An interrupted time series analysis.
BMC Health Serv Res
; 23(1): 160, 2023 Feb 15.
Article
in En
| MEDLINE
| ID: mdl-36793088
ABSTRACT
CONTEXT A patient classification-based payment system called diagnosis-intervention packet (DIP) was piloted in a large city in southeast China in 2018. OBJECTIVE:
This study evaluates the impact of DIP payment reform on total costs, out-of-pocket (OOP) payments, length of stay (LOS), and quality of care in hospitalised patients of different age.METHODS:
An interrupted time series model was employed to examine the monthly trend changes of outcome variables before and after the DIP reform in adult patients, who were stratified into a younger (18-64 years) and an older group (≥ 65 years), further stratified into young-old (65-79 years) and oldest-old (≥ 80 years) groups.RESULTS:
The adjusted monthly trend of costs per case significantly increased in the older adults (0.5%, P = 0.002) and oldest-old group (0.6%, P = 0.015). The adjusted monthly trend of average LOS decreased in the younger and young-old groups (monthly slope change -0.058 days, P = 0.035; -0.025 days, P = 0.024, respectively), and increased in the oldest-old group (monthly slope change 0.107 days, P = 0.030) significantly. The changes of adjusted monthly trends of in-hospital mortality rate were not significant in all age groups.CONCLUSION:
Implementation of the DIP payment reform associated with increase in total costs per case in the older and oldest-old groups, and reduction in LOS in the younger and young-old groups without deteriorating quality of care.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Health Expenditures
/
Inpatients
Type of study:
Health_economic_evaluation
/
Prognostic_studies
Limits:
Aged
/
Aged80
/
Humans
Country/Region as subject:
Asia
Language:
En
Journal:
BMC Health Serv Res
Journal subject:
PESQUISA EM SERVICOS DE SAUDE
Year:
2023
Document type:
Article
Affiliation country:
China