Associations of Chinese diagnosis-related group systems with inpatient expenditures for older people with hip fracture

Zhaolin Meng; Kun Zou; Suhang Song; Huazhang Wu; Youli Han

doi:10.1186/s12877-022-02865-3

Associations of Chinese diagnosis-related group systems with inpatient expenditures for older people with hip fracture

BMC Geriatr. 2022 Mar 1;22(1):169. doi: 10.1186/s12877-022-02865-3.

Authors

Zhaolin Meng¹, Kun Zou^{2

3}, Suhang Song⁴, Huazhang Wu⁵, Youli Han⁶

Affiliations

¹ School of Nursing, Capital Medical University, Beijing, China.
² Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
³ Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
⁴ The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA.
⁵ Department of Health Service Management, China Medical University, Shenyang, Liaoning, China.
⁶ Department of Health Management and Policy, School of Public Health, Capital Medical University, NO 10, Xi Toutiao Rd Youanmenwai District, Beijing, 100069, China. hanyouli@ccmu.edu.cn.

Abstract

Background: Hip fracture is frequent in older people and represents a major public health issue worldwide. The increasing incidence of hip fracture and the associated hospitalization costs place a significant economic burden on older patients and their families. On January 1, 2018, the Chinese diagnosis-related group (C-DRG) payment system, which aims to reduce financial barriers, was implemented in Sanming City, southern China. This study aimed to evaluate the associations of C-DRG system with inpatient expenditures for older people with hip fracture.

Methods: An uncontrolled before-and-after study employed data of all the patients with hip fracture aged 60 years or older from all the public hospitals enrolled in the Sanming Basic Health Insurance Scheme from January 1, 2016 to December 31, 2018. The 'pre C-DRG sample' included patients from January 1, 2016 to December 31, 2017. The 'post C-DRG sample' included patients from January 1, 2018 to December 31, 2018. A propensity score matching analysis was used to adjust the difference in baseline characteristic parameters between the pre and post samples. Data were analyzed using generalized linear models adjusted for the demographic, clinical, and institutional factors. Robust tests were performed by accounting for time trend, the fixed effects of the year and hospitals, and clustering effect within hospitals.

Results: After propensity score matching, we obtained two homogeneous groups of 1123 patients each, and the characteristic variables of the two matched groups were similar. We found that C-DRG reform was associated with a 19.51% decrease in out-of-pocket (OOP) payments (p < 0.001) and a 99.93% decrease in OOP payments as a share of total inpatient expenditure (p < 0.001); whereas total inpatient expenditure was not significantly associated with the C-DRG reform. All the sensitivity analyses did not change the results significantly.

Conclusion: The implementation of C-DRG payment system reduced both the absolute amount of OOP payments and OOP payments as a share of total inpatient expenditure for older patients with hip fracture, without affecting total inpatient expenditure. These results may provide significant insights for policymakers in reducing the financial burden on older patients with hip fracture in other countries.

Keywords: Chinese diagnosis-related group (C-DRG); Hip fracture; Inpatient expenditure; Older people; Out-of-pocket (OOP) payment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
China / epidemiology
Diagnosis-Related Groups
Health Expenditures*
Hip Fractures* / diagnosis
Hip Fractures* / epidemiology
Hip Fractures* / therapy
Humans
Inpatients