AUTHOR=Zou Kun , Peng XiaoFan , Huang Yue , Shi JinMin , He ZhongCheng , Hao YiJia , Liu ChaoJie , Tang Yong , Zhao ShaoYang , Jiang YongMu , Choonara Imti , Zhang LingLi 

TITLE=Impact of hospital payment reform on rational use of antibiotics: a natural experiment

JOURNAL=Frontiers in Public Health

VOLUME=Volume 13 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1638346

DOI=10.3389/fpubh.2025.1638346

ISSN=2296-2565

ABSTRACT=IntroductionWhile numerous studies have examined the effects of diagnosis-related groups (DRG) payment on hospital healthcare, evidence regarding its impact on the quality of hospital healthcare is poor and findings have been inconsistent. This study evaluates how DRG payment reform influences rational use of antibiotics in hospital using the World Health Organization (WHO) Access, Watch, Reserve (AWaRe) classification in China.MethodsWe employed a natural experiment design with difference-in-differences analysis, comparing 10 hospitals implementing DRG payment in two pilot cities with 27 hospitals maintaining fee-for-service (FFS) payment in three control cities in Sichuan Province. Using medicine consumption data from 2016 to 2020 (185 hospital-years), we assessed total antibiotic use/expenditure, Access/Watch group proportions, and Access-to-Watch ratios.ResultsCompared with FFS payment, DRG payment had no significant impact on the total quantity or expenditure of antibiotic use. However, DRG payment led to −13.01% (95% CI: −25.32% to - 0.70%) reduction of proportion of Access antibiotics use and 13.90% (95% CI: 1.97 to 25.83%) increase of proportion Watch antibiotics use. Subgroup analysis showed similar results in both secondary and tertiary hospitals, but greater in the former.DiscussionTDRG hospital payment reform may not affect the total quantity or expenditure of antibiotics use, but decrease the proportion of WHO Access antibiotics use and increase the Watch antibiotics use. Close monitoring and interventions are warranted to improve rational use of antibiotics for health systems during hospital payment reform.