{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T21:23:21Z","timestamp":1786569801356,"version":"build-2736575974"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T00:00:00Z","timestamp":1749513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to assess the impact of implementing the diagnosis-related groups (DRGs) payment system on hospitalization costs and medical service outcomes at a single institution. The objective was to identify effective cost-saving strategies and guide healthcare practices to support the ongoing adoption of the DRGs system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included 616 patients, categorized into three groups based on the payment system in effect during their treatment: a 6-month period under fee-for-service (FFS), a 6-month period following the trial implementation of DRGs (TI-DRGs), and a 6-month period after the official implementation of DRGs (OI-DRGs). Each group was further divided into two subgroups according to the surgical intervention received (either laparoscopic myomectomy or laparoscopic hysterectomy). Data collected included total medical costs, examination fees, surgical costs, medication and supply expenses, length of hospital stay, operation time, intraoperative blood loss, incidence of postoperative anemia, and frequency of blood transfusions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Total medical costs in the OI-DRGs group were 6.6 and 9.0% higher than those in the FFS and TI-DRGs groups, respectively (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). Examination costs followed a similar pattern, with the OI-DRGs group showing increases of 5.3 and 12.3% compared to the FFS and TI-DRGs groups (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). Operation costs also varied significantly among the three groups; the OI-DRGs group incurred 17.1 and 10.5% higher costs than the FFS and TI-DRGs groups, respectively (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). There were no significant differences among the groups in terms of hospital stay duration, operation time, or intraoperative blood loss. In the FFS group, 57 patients developed postoperative anemia and 14 required blood transfusions; in the TI-DRGs group, 52 patients developed anemia and 16 received transfusions; and in the OI-DRGs group, 74 patients developed anemia with 16 requiring transfusions. However, these differences were not statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In summary, the implementation of DRGs for laparoscopic uterine leiomyoma surgery did not lead to a significant reduction in total medical costs. Overall costs were influenced by multiple factors, including the DRG phase, length of stay, type of surgery, and the presence of concurrent procedures. The findings from our single-center study differ from the mainstream view, highlighting that the effects of DRG implementation can be highly context-specific, shaped by local policies, hospital practices, and patient case-mix, which may limit the generalizability of these results beyond our institution or region.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1555444","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T05:22:39Z","timestamp":1749532959000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluating the impact of the diagnosis-related groups payment system on laparoscopic uterine fibroid surgery outcomes: insights from a single-center study"],"prefix":"10.3389","volume":"13","author":[{"given":"Jingjing","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiming","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanshan","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/j.healthpol.2018.04.013","article-title":"Pathways to DRG-based hospital payment systems in Japan, Korea, and Thailand","volume":"122","author":"Annear","year":"2018","journal-title":"Health Policy"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2521","DOI":"10.1016\/s0140-6736(16)30167-2","article-title":"National spending on health by source for 184 countries between 2013 and 2040","volume":"387","author":"Dieleman","year":"2016","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/0168-8510(88)90029-2","article-title":"The impact of DRGs on the cost and quality of health care in the United States","volume":"9","author":"Davis","year":"1988","journal-title":"Health Policy"},{"key":"ref4","first-page":"1055","article-title":"Comparison of medical costs and care of appendectomy patines between fee-for service and set fee for diagnosis-related group systems in 20 Chinese hospitals","volume":"47","author":"Zhang","year":"2016","journal-title":"Southeast Asian J Trop Med Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.jss.2016.08.024","article-title":"Effects of diagnosis-related group payment system on appendectomy outcomes","volume":"206","author":"Kim","year":"2016","journal-title":"J Surg Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/s12913-018-2869-4","article-title":"Effect of diagnosis related groups implementation on the intensive care unit of a Swiss tertiary hospital: a cohort study","volume":"18","author":"Chok","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s12884-018-1698-0","article-title":"Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China","volume":"18","author":"Liu","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1186\/s12913-020-05790-6","article-title":"Impact of DRGs-based inpatient service management on the performance of regional inpatient services in Shanghai, China: an interrupted time series study, 2013-2019","volume":"20","author":"Feng","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1056\/NEJMra1209993","article-title":"Uterine fibroids","volume":"369","author":"Bulun","year":"2013","journal-title":"N Engl J Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1377\/hlthaff.2012.0876","article-title":"Hospital payment based on diagnosis-related groups differs in Europe and holds lessons for the United States","volume":"32","author":"Quentin","year":"2013","journal-title":"Health Aff (Millwood)"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.healthpol.2012.09.011","article-title":"Reforming reimbursement of public hospitals in Greece during the economic crisis: implementation of a DRG system","volume":"109","author":"Polyzos","year":"2013","journal-title":"Health Policy"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1097\/jac.0000000000000141","article-title":"Improving performance, not just what's measured: does the inpatient prospective payment system provide useful lessons?","volume":"39","author":"Berenson","year":"2016","journal-title":"J Ambul Care Manage"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1016\/j.anl.2017.07.005","article-title":"Impact of the Korean diagnosis-related groups payment system on the outcomes of adenotonsillectomy: a single center experience","volume":"45","author":"Kwak","year":"2018","journal-title":"Auris Nasus Larynx"},{"key":"ref14","first-page":"405","article-title":"Impact of a DRG-based hospital financing system on quality and outcomes of care in Italy","volume":"34","author":"Louis","year":"1999","journal-title":"Health Serv Res"},{"key":"ref15","first-page":"1055","article-title":"A study of readmission rates and the implementation of national health insurance","volume":"10","author":"Sari","year":"2017","journal-title":"J Int Dent Med Res"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e018164","DOI":"10.1136\/bmjopen-2017-018164","article-title":"Did case-based payment influence surgical readmission rates in France? A retrospective study","volume":"8","author":"Vuagnat","year":"2018","journal-title":"BMJ Open"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1111\/1475-6773.12749","article-title":"Early impact on outpatients of mandatory adoption of the diagnosis-related group-based reimbursement system in Korea on use of outpatient care: differences in medical utilization and Presurgery examination","volume":"53","author":"Kim","year":"2018","journal-title":"Health Serv Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/s0002-9149(99)00205-2","article-title":"The potential costs of upcoding for heart failure in the United States","volume":"84","author":"Psaty","year":"1999","journal-title":"Am J Cardiol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.jhealeco.2003.09.007","article-title":"Medicare upcoding and hospital ownership","volume":"23","author":"Silverman","year":"2004","journal-title":"J Health Econ"},{"key":"ref20","doi-asserted-by":"crossref","DOI":"10.1257\/000282805775014236","article-title":"How do hospitals respond to Price changes?","author":"Dafny","year":"2005","journal-title":"Am Econ Rev"},{"key":"ref21","doi-asserted-by":"crossref","DOI":"10.1177\/1010539519872325","article-title":"The effect of diagnosis-related groups on the shift of medical services from inpatient to outpatient: a national claims-based analysis","author":"Lee","year":"2019","journal-title":"Asia Pac J Public Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"126","DOI":"10.4174\/astr.2015.88.3.126","article-title":"Early outcome of the Korean diagnosis-related groups payment system for appendectomy","volume":"88","author":"Kim","year":"2015","journal-title":"Ann Surg Treat Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.healthpol.2020.01.007","article-title":"The effects of DRGs-based payment compared with cost-based payment on inpatient healthcare utilization: a systematic review and meta-analysis","volume":"124","author":"Meng","year":"2020","journal-title":"Health Policy"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.healthpol.2012.03.021","article-title":"The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: a population-based study","volume":"107","author":"Cheng","year":"2012","journal-title":"Health Policy"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1984","DOI":"10.1001\/jama.1990.03450150084036","article-title":"Comparing outcomes of care before and after implementation of the DRG-based prospective payment system","volume":"264","author":"Kahn","year":"1990","journal-title":"JAMA"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"j437","DOI":"10.1136\/bmj.j437","article-title":"Value based healthcare","volume":"356","author":"Gray","year":"2017","journal-title":"BMJ"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1555444\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T05:22:41Z","timestamp":1749532961000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1555444\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,10]]},"references-count":26,"alternative-id":["10.3389\/fpubh.2025.1555444"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1555444","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,10]]},"article-number":"1555444"}}