ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Policy
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1524215
Analysis of Factors Influencing Changes in Medical Behavior under the Context of DRG Payment Method Reform: A Structural Equation Modeling Approach
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- 1School of Management, Shandong Second Medical University, Weifang, China
- 2Linyi People's Hospital, Linyi, Shandong Province, China
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Objectives: This study aims to assess the understanding of policies, cognitive awareness, and medical behavior patterns among healthcare workers about the reform of the diagnosis-related group (DRG) payment method. A questionnaire survey was conducted to examine how policy comprehension and cognition influence changes in medical behavior, targeting medical personnel in a northern Chinese city.Methods: An online survey was administered from November to December 2023, covering primary, secondary, and tertiary medical institutions in a city that had implemented DRG payments. The survey gathered demographic data and information on policy comprehension, medical behavior patterns, and policy cognition. Structural equation modeling was employed to analyze the relationships among these factors and their impact on shifts in medical behavior.Results: The findings revealed that policy comprehension did not significantly affect policy cognition. Nonetheless, a higher level of policy comprehension was linked to a negative influence on positive medical behavior (t =-0.115, P < 0.05), and a positive impact on negative medical behavior (t =3.746, P < 0.001). Conversely, positive policy cognition was found to promote positive medical behavior (t =10.756, P < 0.001), while negative policy cognition was associated with an increase in negative behavior (t =12.282, P < 0.001).Conclusion: Behavioral adaptations to DRG reform are driven primarily by cognitive evaluations (positive/negative policy perceptions), not mere policy knowledge. Contrary to expectations, deeper policy understanding correlates with increased negative medical behavior and reduced positive behavior , suggesting that technical training alone may inadvertently incentivize gaming under financial pressures. Positive cognition strongly promotes desirable behaviors, while negative cognition exacerbates detrimental practices. To optimize reform success, China must prioritize value-oriented training (emphasizing DRG's systemic goals over mechanics) and implement intelligent auditing mechanisms to curb high-risk behaviors during transition.
Keywords: DRG, healthcare professionals, Medical behavior, structural equation model, cognitive evaluations
Received: 07 Nov 2024; Accepted: 25 Aug 2025.
Copyright: © 2025 Jiang, Qin, Jiang, Zhang, Guan and Li. 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: Fengming Li, Linyi People's Hospital, Linyi, Shandong Province, China
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