The effects of diagnosis-related groups payment on hospital healthcare in China: a systematic review
The effects of diagnosis-related groups payment on hospital healthcare in China: a systematic review (Springer).
There has been a growing interest in using diagnosis-related groups (DRGs) payment to reimburse inpatient care worldwide. But its effects on healthcare and health outcomes are controversial, and the evidence from low- and middle-income countries (LMICs) is especially scarce. The objective of this study is to evaluate the effects of DRGs payment on healthcare and health outcomes in China.
Method
A systematic review was conducted. We searched literature databases [...]
for empirical studies examining the effects of DRGs
payment on healthcare in mainland China. We performed a narrative synthesis of
outcomes regarding expenditure, efficiency, quality and equity of healthcare,
and assessed the quality of evidence.
Results
[...] DRGs payment mildly reduced the
length of stay. Impairment of equity of healthcare was consistently reported,
especially for patients exempted from DRGs payment, including: patient
selection, cost-shifting and inferior quality of healthcare. However, findings
on total expenditure, out of pocket payment (OOP) and quality of healthcare
were inconsistent. The quality of the evidence was generally low or very low
due to the study design and potential risk of bias of included studies.
Conclusion
DRGs payment may mildly improve the efficiency but impair the equity and
quality of healthcare, especially for patients exempted from this payment
scheme, and may cause up-coding of medical records. However, DRGs payment may
or may not contain the total expenditure or OOP, depending on the components
design of the payment. Policymakers should very carefully consider each
component of DRGs payment design against policy goals. Well-designed randomised
trials or comparative studies are warranted to consolidate the evidence of the
effects of DRGs payment on healthcare and health outcomes in LMICs to inform
policymaking.
Quelle: Springer, 12.02.2020
