ORIGINAL RESEARCH article
Front. Health Serv.
Sec. Implementation Science
Volume 5 - 2025 | doi: 10.3389/frhs.2025.1604023
Effects and Challenges of Implementing the Healthcare Security Diagnosis Related Groups in China: Qualitative Evidence from Healthcare Workers
Provisionally accepted
- Southeast University, Nanjing, China
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Objective: China began exploring the Diagnosis Related Groups (DRGs)-based payment method as part of its healthcare reforms since 2009, and later introduced the Healthcare Security Diagnosis Related Groups (CHS-DRGs) payment method in 30 cities in 2019. While some studies have examined the effects of implementing the DRGs payment method, qualitative evidence is still scarce. This research aimed to gain a comprehensive understanding of impacts and the issues confronted related to the CHS-DRGs payment method from a broader range of stakeholders to provide support for the sustainable development of the payment policy.Methods: A qualitative research was conducted through in-depth interviews with a diverse group of stakeholders, including four directors of hospital health insurance departments, three experts from the Technical Advisory Group of the national DRGs pilot program, seven officials from government health insurance bureaus, two researchers from top-ranking university, and three hospital-based physicians, spanning five provinces in China. Thematic analysis was performed to identify key themes within the qualitative data using the NVivo 11 software.Three key themes emerged from the thematic analysis after reviewing the coded qualitative data, including "perceptions of the CHS-DRGs payment method", "implementation effects" and "challenges". The research participants expressed optimism towards the adoption of the CHS-DRGs payment method, highlighting its beneficial effects in reducing patients' lengths of stay, admissions rates and healthcare costs. However, challenges associated with the adoption of the CHS-DRGs payment method were identified, including issues such as upcoding, admission splitting, and potential deterioration in the quality of care. Future challenges in implementing the CHS-DRGs payment method primarily involve the dynamic adjustment of the grouping approach, the development of a skilled workforce, the refinement of management practices, and the strengthening of policy support.Conclusions: While the CHS-DRGs payment method has the potential to deliver health benefits for patients, it is recommended that monitoring and evaluation systems be developed through collaborative efforts among multiple stakeholders to address the emerging challenges in its successful implementation. The evidence generated from this study provides valuable insights for facilitating the global transition from a retrospective payment system to a prospective payment system.
Keywords: Payment reforms, DRGs, CHS-DRGs, China, Evaluation
Received: 16 Apr 2025; Accepted: 30 Jul 2025.
Copyright: © 2025 Zhang, Fu, Xie, Qiu, Jin and Peng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hua Zhang, Southeast University, Nanjing, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.