A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system
IntroductionIn recent years, China has implemented the Diagnosis Related Groups (DRG) payment system as part of its healthcare insurance reimbursement policy. Numerous studies have focused on the effectiveness of DRG payment system in controlling unreasonable growth in medical expenses. However, the...
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1141981/full |
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| author | Wei-Fu Chang Wei-Fu Chang Wei-Fu Chang Xin-Yu Yan Xin-Yu Yan Hao Ling Ting Liu Ai-Jing Luo Ai-Jing Luo |
| author_facet | Wei-Fu Chang Wei-Fu Chang Wei-Fu Chang Xin-Yu Yan Xin-Yu Yan Hao Ling Ting Liu Ai-Jing Luo Ai-Jing Luo |
| author_sort | Wei-Fu Chang |
| collection | DOAJ |
| description | IntroductionIn recent years, China has implemented the Diagnosis Related Groups (DRG) payment system as part of its healthcare insurance reimbursement policy. Numerous studies have focused on the effectiveness of DRG payment system in controlling unreasonable growth in medical expenses. However, there has been no systematic report on the types of unintended behaviors exhibited by doctors under the DRG payment system.MethodsThe study first utilized interrupted time series analysis to analyze medical records and insurance data from eight hospitals. It investigated the data changes in MDC and ADRG groups before and after the implementation of the DRG payment system. Subsequently, a semi-structured interview method was employed to conduct qualitative research on the unintended behaviors of physicians, aiming to gain a more accurate understanding of specific changes in physician behavior after the implementation of the DRG payment system.ResultsThis study discovered that doctors engage in unintended behaviors within the framework of the DRG payment system.DiscussionIn the early implementation of the DRG payment system in China, the contradictions between the flawed DRG payment methods and supporting systems and the actual diagnostic and treatment work manifested in the form of unintended doctor behaviors. Most of these unintended behaviors can be considered reasonable feedback from doctors to cope with the existing system flaws. They are conducive to identifying the deficiencies in China's DRG payment system and suggesting directions for improvement. |
| first_indexed | 2024-03-13T03:00:26Z |
| format | Article |
| id | doaj.art-4c20abca5acd482c98ffa7a98c75d12e |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-03-13T03:00:26Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-4c20abca5acd482c98ffa7a98c75d12e2023-06-27T13:08:57ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-06-011110.3389/fpubh.2023.11419811141981A study of the types and manifestations of physicians' unintended behaviors in the DRG payment systemWei-Fu Chang0Wei-Fu Chang1Wei-Fu Chang2Xin-Yu Yan3Xin-Yu Yan4Hao Ling5Ting Liu6Ai-Jing Luo7Ai-Jing Luo8Department of Medical Administration, The Third Xiangya Hospital of Central South University, Changsha, ChinaXiangya School of Public Health, Central South University, Changsha, ChinaKey Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, ChinaKey Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, ChinaSchool of Life Sciences, Central South University, Changsha, ChinaDepartment of Medical Administration, The Third Xiangya Hospital of Central South University, Changsha, ChinaSchool of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, ChinaInformation Network Center, The Second Xiangya Hospital of Central South University, Changsha, ChinaClinical Research Center for Cardiovascular Intelligent Healthcare in Hunan Province, Changsha, ChinaIntroductionIn recent years, China has implemented the Diagnosis Related Groups (DRG) payment system as part of its healthcare insurance reimbursement policy. Numerous studies have focused on the effectiveness of DRG payment system in controlling unreasonable growth in medical expenses. However, there has been no systematic report on the types of unintended behaviors exhibited by doctors under the DRG payment system.MethodsThe study first utilized interrupted time series analysis to analyze medical records and insurance data from eight hospitals. It investigated the data changes in MDC and ADRG groups before and after the implementation of the DRG payment system. Subsequently, a semi-structured interview method was employed to conduct qualitative research on the unintended behaviors of physicians, aiming to gain a more accurate understanding of specific changes in physician behavior after the implementation of the DRG payment system.ResultsThis study discovered that doctors engage in unintended behaviors within the framework of the DRG payment system.DiscussionIn the early implementation of the DRG payment system in China, the contradictions between the flawed DRG payment methods and supporting systems and the actual diagnostic and treatment work manifested in the form of unintended doctor behaviors. Most of these unintended behaviors can be considered reasonable feedback from doctors to cope with the existing system flaws. They are conducive to identifying the deficiencies in China's DRG payment system and suggesting directions for improvement.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1141981/fullDRG paymentunintended behaviorsphysiciansinterrupted time series analysisnegotiation mechanism |
| spellingShingle | Wei-Fu Chang Wei-Fu Chang Wei-Fu Chang Xin-Yu Yan Xin-Yu Yan Hao Ling Ting Liu Ai-Jing Luo Ai-Jing Luo A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system Frontiers in Public Health DRG payment unintended behaviors physicians interrupted time series analysis negotiation mechanism |
| title | A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system |
| title_full | A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system |
| title_fullStr | A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system |
| title_full_unstemmed | A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system |
| title_short | A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system |
| title_sort | study of the types and manifestations of physicians unintended behaviors in the drg payment system |
| topic | DRG payment unintended behaviors physicians interrupted time series analysis negotiation mechanism |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1141981/full |
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