Analysis of the impact of China Healthcare Security diagnosis-related groups payment reform on the hospitalization costs for uvulopalatopharyngoplasty in obstructive sleep apnea patients at Hospital C.

BACKGROUND

As part of China's medical insurance-related grouping payment reform, public hospitals, which are the primary providers of medical insurance services, face remarkable pressure to control costs. This study examined uvulopalatopharyngoplasty (UPPP) surgery for patients with obstructive sleep apnea (OSA) at Hospital C to identify factors influencing inpatient costs and assess the impact of payment reform on treatment practices.

METHODS

Using data from 251 OSA patients undergoing UPPP at Hospital C, the study evaluated changes in cost reduction, cost structure, patient disease severity, and medical quality before and after the payment reform.

RESULTS

Inpatient costs for OSA patients undergoing UPPP surgery significantly decreased following the trial implementation of CHS-DRG, with notable reductions in medication and consumable expenses, as well as a shorter length of hospitalization. The CHS-DRG reform did not affect illness severity, patient safety during hospitalization, or long-term surgical outcomes for OSA patients.

CONCLUSION

After the CHS-DRG reform, Hospital C proactively adjusted clinical pathways to manage costs and improve inpatient turnover efficiency without resorting to cost-shifting, patient refusal, or staged surgeries. Despite the financial pressures, hospitals should aim to establish a win-win mechanism between hospitals, physicians, and patients, enhance internal management, and improve financial performance. Additionally, medical security authorities should explore more precise DRG payments and value-based payment models to promote high-quality hospital development rather than impose constraints.

STUDY APPROVAL: This study was approved by the Ethics Committee of Beijing Tsinghua Changgung Hospital (Approval No. 23418-0-02).