Comparative Analysis of "Same Disease, Same Price" Policy in Diagnosis Related Group Payment Under the Goal of Tiered Healthcare Delivery

Abstract

ObjectiveTo compare and analyze the "same disease, same price" policy in the regionsimplementing diagnosis related group(DRG) payment reform, and to provide recommendations for further policy optimization and extension.MethodsDRG policies published on official website of healthcare security bureaus from all provinces and 190 cities between 1 January 2019 to 31 May 2024 were collected. Microsoft excel was applied to collect the information, and the comparative analysis method was used to summarize and analyze the DRG polices from three dimensions: region, healthcare facility, and disease groups coverage.ResultsThe regions where the "same disease, same price" policy in DRG payment was implemented were limited and unevenly distributed. The policy has been implemented in 76 cities across 16 provinces, 2 municipalities, and 3 autonomous regions, accounting for 40% of the cities implementing DRG payment. The pilot cities were mainly concentrated in eastern China. Coverage of healthcare facilities varied across regions. This policy covered all levels of healthcare institutions in most of the pilot cities, while it was primarily implemented in secondary and tertiary hospitals in some regions. The selection criteria for primary disease groups were generally consistent: the common diseases with mature diagnostic, treatment techniques and stable medical costs. However, the number, relative weight, and distribution of primary disease groups varied across regions, with the number ranging from 3 to 117 and relative weight ranging from 0.16 to 1.57. The primary diseases were mainly concentrated in internal diseases, with asthma and hypertension being the most common disease groups.ConclusionIt is recommended to expand the scope of region coverage, determine the scope of hospital coverage according to local capacities, expand the scope of disease groups by stages, and evaluate the effect of policy implementation.

Keywords

• diagnosis related group
• tiered healthcare delivery
• primary disease group
• same price for same disease
• comparative analysis