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. 2025 Jun 2:13:1572475.
doi: 10.3389/fpubh.2025.1572475. eCollection 2025.

The implementation effect of DIP payment method across different population in Southwest China based on multi-group interrupt time series

Lixiang Wu  1 , Ni Wu  1 , Yuhan Cao  2 , Xiaoyuan Zhou  1
Affiliations

The implementation effect of DIP payment method across different population in Southwest China based on multi-group interrupt time series

Lixiang Wu et al. Front Public Health. .

Abstract

Background: Since 2020, China has implemented a payment method known as "Diagnosis-Intervention Package" (DIP) in 71 cities nationwide to address the specific needs of the country. The objective of this study is to evaluate the impact of DIP on medical quality and the burden experienced by inpatients covered under the Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI). Furthermore, it aims to investigate potential differences in these effects between inpatients enrolled in the two distinct types of insurance, thereby enhancing our understanding of how this reform in payment methods influences healthcare delivery, and refine the social security system.

Methods: We conducted a multiple-group interrupted time series analyses (MGITSA) on outcome variables reflecting medical services quality, and the burden of UEBMI and URRBMI inpatients, based on a dataset containing 180,071 inpatient reimbursement records in City C spanning from January, 2019 to December, 2021. This dataset included 42,581 records for URRBMI inpatients and 137,490 records for UEBMI inpatients.

Results: After DIP implementation, both UEBMI and URRBMI showed increased inpatient numbers (21.59% and 22.26%, respectively), reduced LOS (7.10% for UEBMI, 0.29% for URRBMI), and higher ACR (3.07% for UEBMI, 15.36% for URRBMI). Hospitalization costs increased slightly for both groups (2.97% for UEBMI, 10.44% for URRBMI). Subgroup analysis revealed age-specific differences: significant LOS and cost changes in <18-year-olds and >45-year-olds, but minimal effects in 18-45-year-olds. MGITSA showed URRBMI experienced significant LOS reduction (β3=-0.004, P=0.014), while UEBMI had more pronounced LOS and ACR trends, with no significant inter-group differences in cost slopes.

Conclusion: DIP improved hospital efficiency (reduced LOS, increased admissions) and financial protection (higher ACR) for both insurance groups in the short term, though hospitalization costs rose, requiring attention to potential service intensity inflation or cost-shifting. Age disparities in DIP impacts highlight the need for targeted policies. Continuous monitoring and policy adjustments are essential to balance cost control, service quality, and equity, ensuring DIP's long-term effectiveness in China's healthcare reform.

Keywords: Diagnosis-Intervention Packet; mandatory medical insurance; medical efficiency; medical services quality; the burden of patients.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Visual depiction of two-group interrupted time-series analysis.
Figure 2
Figure 2
Trend changes regarding efficiency, quality, and burden of inpatients in two groups. (a) The trends of actual compensation ratio, (b) The trends of number of inpatients, (c) The trends of average length of stay, (d) The trends of average of hospitalization costs.
Figure 3
Figure 3
Trends of the number of inpatients before and after DIP reform.
Figure 4
Figure 4
Trend comparison of the average LOS of inpatients before and after DIP.
Figure 5
Figure 5
Variation of the average hospitalization costs before and after DIP.
Figure 6
Figure 6
The change of the actual compensation ration of inpatients.
See this image and copyright information in PMC

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