PMID- 37441652
OWN - NLM
STAT- MEDLINE
DCOM- 20230717
LR  - 20240420
IS  - 2296-2565 (Electronic)
IS  - 2296-2565 (Linking)
VI  - 11
DP  - 2023
TI  - A study of the types and manifestations of physicians' unintended behaviors in 
      the DRG payment system.
PG  - 1141981
LID - 10.3389/fpubh.2023.1141981 [doi]
LID - 1141981
AB  - INTRODUCTION: In 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. METHODS: The 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. 
      RESULTS: This study discovered that doctors engage in unintended behaviors within 
      the framework of the DRG payment system. DISCUSSION: In 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.
CI  - Copyright (c) 2023 Chang, Yan, Ling, Liu and Luo.
FAU - Chang, Wei-Fu
AU  - Chang WF
AD  - Department of Medical Administration, The Third Xiangya Hospital of Central South 
      University, Changsha, China.
AD  - Xiangya School of Public Health, Central South University, Changsha, China.
AD  - Key Laboratory of Medical Information Research (Central South University), 
      College of Hunan Province, Changsha, China.
FAU - Yan, Xin-Yu
AU  - Yan XY
AD  - Key Laboratory of Medical Information Research (Central South University), 
      College of Hunan Province, Changsha, China.
AD  - School of Life Sciences, Central South University, Changsha, China.
FAU - Ling, Hao
AU  - Ling H
AD  - Department of Medical Administration, The Third Xiangya Hospital of Central South 
      University, Changsha, China.
FAU - Liu, Ting
AU  - Liu T
AD  - School of International Pharmaceutical Business, China Pharmaceutical University, 
      Nanjing, China.
FAU - Luo, Ai-Jing
AU  - Luo AJ
AD  - Information Network Center, The Second Xiangya Hospital of Central South 
      University, Changsha, China.
AD  - Clinical Research Center for Cardiovascular Intelligent Healthcare in Hunan 
      Province, Changsha, China.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230627
PL  - Switzerland
TA  - Front Public Health
JT  - Frontiers in public health
JID - 101616579
SB  - IM
MH  - Humans
MH  - *Diagnosis-Related Groups
MH  - Health Policy
MH  - *Physicians
MH  - Hospitals, Public
MH  - China
PMC - PMC10333571
OTO - NOTNLM
OT  - DRG payment
OT  - interrupted time series analysis
OT  - negotiation mechanism
OT  - physicians
OT  - unintended behaviors
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2023/07/13 19:14
MHDA- 2023/07/17 06:42
PMCR- 2023/06/27
CRDT- 2023/07/13 15:32
PHST- 2023/01/12 00:00 [received]
PHST- 2023/06/12 00:00 [accepted]
PHST- 2023/07/17 06:42 [medline]
PHST- 2023/07/13 19:14 [pubmed]
PHST- 2023/07/13 15:32 [entrez]
PHST- 2023/06/27 00:00 [pmc-release]
AID - 10.3389/fpubh.2023.1141981 [doi]
PST - epublish
SO  - Front Public Health. 2023 Jun 27;11:1141981. doi: 10.3389/fpubh.2023.1141981. 
      eCollection 2023.