120017
论文已发表
注册即可获取德孚的最新动态
IF 收录期刊
- 3.6 Breast Cancer (Dove Med Press)
- 4.3 Clin Epidemiol
- 2.6 Cancer Manag Res
- 3.2 Infect Drug Resist
- 4.1 Clin Interv Aging
- 6.1 Drug Des Dev Ther
- 4.1 Int J Chronic Obstr
- 8.7 Int J Nanomed
- 2.5 Int J Women's Health
- 3.2 Neuropsych Dis Treat
- 2.4 OncoTargets Ther
- 2.6 Patient Prefer Adher
- 2.6 Ther Clin Risk Manag
- 3.1 J Pain Res
- 3.5 Diabet Metab Synd Ob
- 4.5 Psychol Res Behav Ma
- 3.4 Nat Sci Sleep
- 2.4 Pharmgenomics Pers Med
- 2.6 Risk Manag Healthc Policy
- 4.6 J Inflamm Res
- 2.3 Int J Gen Med
- 3.9 J Hepatocell Carcinoma
- 3.3 J Asthma Allergy
- 2.5 Clin Cosmet Investig Dermatol
- 3.0 J Multidiscip Healthc
已发表论文
诊断-干预包（DIP）支付改革对县级医院的影响：来自中国 Z 市的证据
Received 27 July 2025
Accepted for publication 30 January 2026
Published 13 February 2026 Volume 2026:18 556559
DOI https://doi.org/10.2147/JHL.S556559
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Russell Taichman
Xinyi Peng,1 Huawei Tan,1,* Yingchun Chen1,2,*
1Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Research Centre for Rural Health Service, Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yingchun Chen, Email chenyingchunhust@163.com Huawei Tan, Email tanhuawei-2009@163.com
Background: In 2020, China introduced an innovative case-based payment method called “Diagnosis-Intervention Packet (DIP).” However, the implementation of DIP may present significant challenges to county hospitals. Therefore, this study aims to assess the impact of DIP on inpatient Volume and inpatient medical revenue at county hospitals, as well as its effect on patient flow.
Methods: We collected detailed data on inpatient expenses and reimbursements from the Z City Medical Insurance Bureau for the years 2020– 2022, encompassing a total of 5,339,996 records. A single-group interrupted time series analysis was conducted to examine changes in inpatient volumes and their regional distribution across municipal hospitals, county hospitals, and primary healthcare institutions before and after the DIP reform. Additionally, the impact of the reform on medical revenue at county hospitals and its regional share was analyzed. Heterogeneity by insurance type was also explored.
Results: Following the implementation of the DIP reform, county hospitals experienced significant declines in both inpatient volume and inpatient medical revenue growth. Monthly inpatient visits decreased by 610.4 (p=0.063), with their market share dropping 0.28% (p=0.003). The impact was particularly pronounced for patients with Urban-Rural Residents Basic Medical Insurance (URRBMI), where monthly volume fell by 1,228.13 (p=0.012) and share decreased by 0.39% (p< 0.001). Inpatient medical revenue growth reversed significantly, with the slope decreasing 3.58% (p=0.014) and regional share falling 0.38% (p=0.008).
Conclusion: DIP implementation creates significant challenges for county hospitals through patient diversion to primary facilities and increased competition with municipal hospitals. This threatens to create a cycle of declining volume, revenue, and capabilities. To prevent rural patients from being forced to seek care at distant urban facilities, policy interventions should focus on providing targeted support to maintain county hospitals’ vital role in rural healthcare delivery.
Keywords: DIP, case-based payment system, county hospitals, inpatient volume, medical revenue
1Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Research Centre for Rural Health Service, Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yingchun Chen, Email chenyingchunhust@163.com Huawei Tan, Email tanhuawei-2009@163.com
Background: In 2020, China introduced an innovative case-based payment method called “Diagnosis-Intervention Packet (DIP).” However, the implementation of DIP may present significant challenges to county hospitals. Therefore, this study aims to assess the impact of DIP on inpatient Volume and inpatient medical revenue at county hospitals, as well as its effect on patient flow.
Methods: We collected detailed data on inpatient expenses and reimbursements from the Z City Medical Insurance Bureau for the years 2020– 2022, encompassing a total of 5,339,996 records. A single-group interrupted time series analysis was conducted to examine changes in inpatient volumes and their regional distribution across municipal hospitals, county hospitals, and primary healthcare institutions before and after the DIP reform. Additionally, the impact of the reform on medical revenue at county hospitals and its regional share was analyzed. Heterogeneity by insurance type was also explored.
Results: Following the implementation of the DIP reform, county hospitals experienced significant declines in both inpatient volume and inpatient medical revenue growth. Monthly inpatient visits decreased by 610.4 (p=0.063), with their market share dropping 0.28% (p=0.003). The impact was particularly pronounced for patients with Urban-Rural Residents Basic Medical Insurance (URRBMI), where monthly volume fell by 1,228.13 (p=0.012) and share decreased by 0.39% (p< 0.001). Inpatient medical revenue growth reversed significantly, with the slope decreasing 3.58% (p=0.014) and regional share falling 0.38% (p=0.008).
Conclusion: DIP implementation creates significant challenges for county hospitals through patient diversion to primary facilities and increased competition with municipal hospitals. This threatens to create a cycle of declining volume, revenue, and capabilities. To prevent rural patients from being forced to seek care at distant urban facilities, policy interventions should focus on providing targeted support to maintain county hospitals’ vital role in rural healthcare delivery.
Keywords: DIP, case-based payment system, county hospitals, inpatient volume, medical revenue