ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1633222
This article is part of the Research TopicPublic Health Outcomes: The Role of Social Security Systems in Improving Residents' Health WelfareView all 84 articles
The effects of the Diagnosis-Intervention Packet (DIP) payment reform in China: Evidence from Guangzhou
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- 1School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- 2Southeast University Zhongda Hospital, Nanjing, China
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Background: This study evaluated the impact of Guangzhou's Diagnosis-Intervention Packet (DIP) payment reform, introduced as an alternative to the traditional fee-for-service (FFS) model, on inpatient costs, patients' out-of-pocket (OOP) payments, hospital length of stay (LOS) and 30day readmission rate.We conducted a single-group interrupted time series analysis using monthly data from the Guangzhou Urban Employee Basic Medical Insurance Scheme, spanning January 2017 to June 2020. Outcome indicators included inpatient cost per case, medication expenditures, medical consumables expenditures, diagnostic and therapeutic service expenditures, OOP payments, LOS and 30-day readmission rate.Results: While the DIP reform was associated with a modest reduction in the rate of LOS decline, it did not significantly lower inpatient cost. Instead, total inpatient expenditures exhibited a sustained upward trend in the post-reform period. Moreover, OOP payments per case increased significantly following the reform, indicating a heavier financial burden on patients. Sub-item analysis revealed that medication expenditures declined and stabilized after a pre-policy drop, whereas diagnostic and therapeutic service expenditures continued to grow without evident signs of deceleration. The 30-day readmission rate remained largely stable throughout the study period.The DIP reform in Guangzhou did not achieve its intended goals of reducing inpatient expenditures or alleviating patients' financial burdens. These unintended effects were driven by the incentive structure of the DIP system-particularly its reliance on historical cost data for RW calculation and its reimbursement deduction method-which encouraged hospitals to shift costs and elevate OOP payments. Policymakers should reassess DIP's algorithmic parameters and strengthen cost-accounting transparency to ensure more equitable and efficient medical insurance fund allocation.
Keywords: DIP payment reform, inpatient costs, out-of-pocket payments, Interrupted time series analysis, Policy evaluation
Received: 23 May 2025; Accepted: 11 Aug 2025.
Copyright: © 2025 Wang, Huang, Lu, Xu, Wang and Xu. 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: Wei Xu, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
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