{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T08:31:55Z","timestamp":1759825915690,"version":"3.44.0"},"reference-count":78,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100021171","name":"Basic and Applied Basic Research Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["SL2022A04J01523"],"award-info":[{"award-number":["SL2022A04J01523"]}],"id":[{"id":"10.13039\/501100021171","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011322","name":"Macau University of Science and Technology Foundation","doi-asserted-by":"publisher","award":["FRG-24-040-MSB"],"award-info":[{"award-number":["FRG-24-040-MSB"]}],"id":[{"id":"10.13039\/501100011322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Diagnosis-related group (DRG) systems for healthcare reimbursement were recently introduced among hospitals in China, raising concerns about cost-shifting, where hospitals may increase charges for self-financing patients to offset reimbursement cuts by DRG. In 2018, both Nanchang and Ganzhou Cities in Jiangxi Province installed DRG information systems, but only Nanchang fully implemented the DRG system during the 2019\u20132020 pilot period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Drawing from a healthcare administrative dataset of 14,310 patients' records, this study investigates the hospitalization costs associated with Intraocular Lens (IOL) implantation procedures in Jiangxi Province, China, from 2017 to 2020. By applying the quantile difference-in-differences (DID) and difference-in-difference-in-difference (DDD) methodologies, the research examines the impacts of DRG implementation on hospitalization costs, with a particular focus on self-financing patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Upon the implementation of DRG in hospitals in Nanchang, the IOL cost ratio for patients in Nanchang was lower on average by 0.047 (<jats:italic>p<\/jats:italic> &amp;lt; <jats:italic>0.001<\/jats:italic>), with the largest reduction observed at higher quantiles (e.g., Q75: \u22120.105, Q90: \u22120.091) (<jats:italic>p<\/jats:italic> &amp;lt; <jats:italic>0.001<\/jats:italic>). The DDD model revealed a decrease of 0.226 in the IOL cost ratio for self-financing patients in DRG hospitals post-implementation. These results remained robust across various healthcare cost ratios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The study indicates that implementing the DRG system in Chinese hospitals effectively constrained healthcare costs without causing unintended cost-shifting among self-financing patients. The system's heightened impacts on higher quantiles indicate its efficacy in addressing high-cost outliers. These outcomes are likely attributed to the centralized medical procurement and healthcare information technology integrated into the Chinese healthcare system.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1582001","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T04:14:34Z","timestamp":1755663274000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost shifting or cost cutting by hospitals as a response to reimbursement reform? The case of diagnosis-related groups (DRG) scheme in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiabi","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinyun","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuan","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yijun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinghua","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyu","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"B1","unstructured":"Health expenditure and financing: Health expenditure indicators\n          \n          \n          \n          2024"},{"article-title":"Diagnosis related groups in Europe: uses and perspectives","year":"2012","author":"Fetter","key":"B2"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/QMH.0b013e3181ccbcc3","article-title":"The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital","volume":"19","author":"Goldfield","year":"2010","journal-title":"Qual Manag Healthcare."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2333392816647892","DOI":"10.1177\/2333392816647892","article-title":"Review of diagnosis-related group-based financing of hospital care","volume":"3","author":"Mihailovic","year":"2016","journal-title":"Health Serv Res Manag Epidemiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3233\/THC-240110","article-title":"Diagnosis-Related Groups payment reform and hospital cost control","volume":"33","author":"Lin","year":"2025","journal-title":"Tech Health Care."},{"key":"B6","doi-asserted-by":"publisher","first-page":"21212","DOI":"10.1038\/s41598-024-71917-y","article-title":"Impact of Diagnosis-Related Groups (DRG) reform on cost homogeneity of treatment for patients with malignant tumours","volume":"14","author":"Zheng","year":"2024","journal-title":"Sci Rep."},{"key":"B7","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1002\/hpm.3739","article-title":"Impacts of a new diagnosis-related group point payment system on children's medical services in China: Length of stay and costs","volume":"39","author":"Wang","year":"2024","journal-title":"Int J Health Plann Manage."},{"key":"B8","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1186\/s12913-023-09686-z","article-title":"Impact of Diagnosis-Related-Group (DRG) payment on variation in hospitalization expenditure: evidence from China","volume":"23","author":"Li","year":"2023","journal-title":"BMC Health Serv Res."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1016\/S0140-6736(10)60063-3","article-title":"Realignment of incentives for health-care providers in China","volume":"375","author":"Yip","year":"2010","journal-title":"Lancet."},{"key":"B10","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1136\/bmj.f3197","article-title":"Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals?","author":"Busse","year":"2013","journal-title":"BMJ."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2263","DOI":"10.2147\/RMHP.S308183","article-title":"Lihua Sun. Impacts of diagnosis-related groups payment on the healthcare providers' behavior in China: a cross-sectional study among physicians","volume":"14","author":"Zhang","year":"2021","journal-title":"Risk Manag Healthcare Policy."},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.W3.472","article-title":"Can hospitals and physicians shift the effects of cuts in medicare reimbursement to private payers? Cost shifting is more pronounced under certain conditions, but there definitely is an economic basis for its existence","author":"Ginsburg","year":"2003","journal-title":"Health Affairs."},{"key":"B13","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1215\/03616878-8-4-660","article-title":"Cross-subsidies and payment for hospital care","volume":"8","author":"Sloan","year":"1984","journal-title":"J Health Polit Policy Law."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1086\/tpe.12.20061853","article-title":"Cost shifting or cost cutting?","volume":"12","author":"Cutler","year":"1998","journal-title":"Tax Policy Econ."},{"key":"B15","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1377\/hlthaff.25.1.197","article-title":"Evidence of cost shifting in California hospitals","volume":"25","author":"Zwanziger","year":"2006","journal-title":"Health Aff."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1377\/hlthaff.2011.0220","article-title":"Hospitals respond to Medicare payment shortfalls by both shifting costs and cutting them, based on market concentration","volume":"30","author":"Robinson","year":"2011","journal-title":"Health Aff."},{"key":"B17","first-page":"340","article-title":"Dynamic cost shifting in hospitals: Evidence from the 1980s and 1990s","volume":"34","author":"Clement","year":"1997","journal-title":"Inquiry"},{"key":"B18","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1377\/hlthaff.4.3.67","article-title":"Hospital cost shifting and care for the uninsured","volume":"4","author":"Hadley","year":"1985","journal-title":"Health Aff."},{"key":"B19","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1001\/jama.2009.1278","article-title":"Cost shifting does not reduce the cost of health care","volume":"302","author":"Fuchs","year":"2009","journal-title":"Jama."},{"key":"B20","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/0167-6296(88)90004-5","article-title":"Pricing by non-profit institutions: the case of hospital cost-shifting","volume":"7","author":"Dranove","year":"1988","journal-title":"J Health Econ."},{"key":"B21","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1377\/hlthaff.15.3.215","article-title":"Do physicians cost shift?","volume":"15","author":"Rice","year":"1996","journal-title":"Health Aff."},{"key":"B22","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1215\/03616878-7-4-945","article-title":"The impact of public health care financing policies on private-sector hospital costs","volume":"7","author":"Hay","year":"1983","journal-title":"J Health Polit Policy Law."},{"key":"B23","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1111\/j.1468-0009.2011.00621.x","article-title":"How much do hospitals cost shift? A review of the evidence","volume":"89","author":"Frakt","year":"2011","journal-title":"Milbank Q."},{"article-title":"Cost shifting in health care: Separating evidence from rhetoric","year":"1994","author":"Morrisey","key":"B24"},{"key":"B25","doi-asserted-by":"publisher","first-page":"102319","DOI":"10.1016\/j.jhealeco.2020.102319","article-title":"Do hospitals respond to changing incentive structures? Evidence from Medicare's 2007 DRG restructuring","volume":"73","author":"Cook","year":"2020","journal-title":"J Health Econ"},{"key":"B26","first-page":"1","article-title":"Cost-shifting and cost-cutting as joint and mutually reinforcing strategies in the financial management of hospitals and similar healthcare organizations","volume":"47","author":"Mendoza","year":"2020","journal-title":"J Health Care Finance."},{"key":"B27","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1377\/hlthaff.25.1.22","article-title":"The cost-shift payment \u2018hydraulic': foundation, history, and implications","volume":"25","author":"Dobson","year":"2006","journal-title":"Health Aff."},{"key":"B28","doi-asserted-by":"publisher","first-page":"553","DOI":"10.2105\/AJPH.78.5.553","article-title":"Case shifting and the Medicare Prospective Payment System","volume":"78","author":"Sloan","year":"1988","journal-title":"American J Public Health."},{"key":"B29","first-page":"163","article-title":"Medicaid-dependent hospitals and their patients: how have they fared?","volume":"33","author":"Dranove","year":"1998","journal-title":"Health Serv Res."},{"key":"B30","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/0167-6296(87)90007-5","article-title":"Commercial insurers and all-payer regulation: Evidence on hospitals' responses to financial need","volume":"6","author":"Zuckerman","year":"1987","journal-title":"J Health Econ."},{"key":"B31","doi-asserted-by":"publisher","first-page":"127","DOI":"10.18278\/epa.1.1.9","article-title":"Bending the rules to play the game: Accountability, DRG and waiting list scandals in Norway and Germany","volume":"1","author":"Neby","year":"2015","journal-title":"European Policy Analysis."},{"key":"B32","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1257\/pol.20160060","article-title":"Financial incentives, hospital care, and health outcomes: evidence from fair pricing laws","volume":"9","author":"Batty","year":"2017","journal-title":"American Economic Journal: Economic Policy."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1923","DOI":"10.1377\/hlthaff.2012.0323","article-title":"The lessons of Medicare's prospective payment system show that the bundled payment program faces challenges","volume":"31","author":"Altman","year":"2012","journal-title":"Health Aff."},{"key":"B34","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1177\/0163278702025003001","article-title":"Shifting costs from high-cost to low-cost diagnosis-related groups?","volume":"25","author":"Saint","year":"2002","journal-title":"Eval Health Prof."},{"key":"B35","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/s10754-009-9071-5","article-title":"Hospital cost shifting revisited: new evidence from the balanced budget act of 1997","volume":"10","author":"Wu","year":"2010","journal-title":"Int J Health Care Finance Econ."},{"key":"B36","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1002\/(sici)1099-1050(200004)9:3<211::aid-hec508>3.0.co;2-k","article-title":"Can cost shifting continue in a price competitive environment?","volume":"9","author":"Zwanziger","year":"2000","journal-title":"Health Economics."},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1674-3830.2015.04.022","article-title":"Application of DRGs in Beijing's medical insurance payment management","author":"Zhang","year":"2015","journal-title":"Chinese Health Insurance"},{"key":"B38","doi-asserted-by":"publisher","first-page":"104990","DOI":"10.1016\/j.healthpol.2023.104990","article-title":"The end of an era? Activity-based funding based on diagnosis-related groups: a review of payment reforms in the inpatient sector in 10 high-income countries","volume":"141","author":"Milstein","year":"2024","journal-title":"Health Policy"},{"key":"B39","doi-asserted-by":"publisher","first-page":"2522","DOI":"10.3390\/ijerph20032522","article-title":"Cost sharing and cost shifting mechanisms under a per diem payment system in a county of China","volume":"20","author":"Liu","year":"2023","journal-title":"Int J Environ Res Public Health."},{"key":"B40","doi-asserted-by":"publisher","first-page":"114415","DOI":"10.1016\/j.socscimed.2021.114415","article-title":"The pilot of a new patient classification-based payment system in China: the impact on costs, length of stay and quality","volume":"289","author":"Qian","year":"2021","journal-title":"Soc Sci Med."},{"key":"B41","doi-asserted-by":"publisher","first-page":"415","DOI":"10.2147\/RMHP.S400385","article-title":"Impacts of outpatient payment reforms on volume and expenditures in public hospitals: evidence from a quasi-experimental analysis in Zhejiang, China","volume":"16","author":"Zhang","year":"2023","journal-title":"Risk Manag Healthc Policy."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-020-4957-5","article-title":"The effects of diagnosis-related groups payment on hospital healthcare in China: a systematic review","volume":"20","author":"Zou","year":"2020","journal-title":"BMC Health Serv Res."},{"key":"B43","unstructured":"Does DRG lead to a decrease in medical income?\n          \n          \n          \n          2024"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1080\/13504850903317347","article-title":"The impact of a diagnosis-related group-based prospective payment experiment: the experience of Shanghai","volume":"17","author":"Zhang","year":"2010","journal-title":"Appl Econ Lett."},{"key":"B45","doi-asserted-by":"publisher","first-page":"l4015","DOI":"10.1136\/bmj.l4015","article-title":"Reforming public hospital financing in China: progress and challenges","volume":"365","author":"Xu","year":"2019","journal-title":"BMJ."},{"key":"B46","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1093\/heapol\/czt023","article-title":"The hospital of the future in China: China's reform of public hospitals and trends from industrialized countries","volume":"29","author":"Barber","year":"2014","journal-title":"Health Policy Plan."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1431991","DOI":"10.3389\/fpubh.2024.1431991","article-title":"How significant is cost-shifting behavior under the diagnosis intervention packet payment reform?","volume":"12","author":"Tan","year":"2024","journal-title":"Front Public Health."},{"key":"B48","doi-asserted-by":"publisher","first-page":"238","DOI":"10.18502\/ijph.v48i2.818","article-title":"Impacts of hospital payment based on diagnosis related groups (DRGs) with global budget on resource use and quality of care: a case study in China","volume":"48","author":"Suwei","year":"2019","journal-title":"Iran J Public Health."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1745","DOI":"10.1377\/hlthaff.2015.0074","article-title":"Payment reform pilot in Beijing hospitals reduced expenditures and out-of-pocket payments per admission","volume":"34","author":"Jian","year":"2015","journal-title":"Health Aff."},{"key":"B50","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1002\/hec.602","article-title":"Provider payment reform in China: the case of hospital reimbursement in Hainan province","volume":"10","author":"Yip","year":"2001","journal-title":"Health Econ."},{"key":"B51","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.healthpol.2003.09.010","article-title":"The impact of urban health insurance reform on hospital charges: a case study from two cities in China","volume":"68","author":"Meng","year":"2004","journal-title":"Health Policy."},{"key":"B52","unstructured":"Chinese hospital bed occupancy analysis: 1988\u20131997\n          \n          \n            \n              Xue\n              M\n            \n            \n              Mao\n              J\n            \n            \n              Chen\n              Y\n            \n          \n          Chinese Hosp Manage\n          \n          1999"},{"key":"B53","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1136\/bjophthalmol-2013-304047","article-title":"Prevalence and causes of vision loss in East Asia: 1990\u20132010","volume":"98","author":"Wong","year":"2014","journal-title":"Br J Ophthalmol."},{"key":"B54","unstructured":"Jiangxi Province: 250,000 cataract patients will be able to receive free sight restoration surgery\n          \n          \n          \n          2009"},{"key":"B55","doi-asserted-by":"publisher","first-page":"303","DOI":"10.16462\/j.cnki.zhjbkz.2024.03.009","article-title":"Cataract surgery incidence and influencing factors in middle-aged and elderly Chinese: a prospective cohort study","volume":"28","author":"Xin","year":"2024","journal-title":"Chin J Dis Contr Prevent."},{"key":"B56","doi-asserted-by":"publisher","first-page":"625","DOI":"10.3760\/cma.j.issn.0412-4081.2019.08.016","article-title":"Analysis of the prevalence of blindness and major blinding diseases in China","volume":"55","author":"Gao","year":"2019","journal-title":"Chin J Ophthalmol."},{"key":"B57","doi-asserted-by":"publisher","first-page":"08004","DOI":"10.7189\/jogh.11.08004","article-title":"Prevalence of visual impairment among older Chinese population: A systematic review and meta-analysis","volume":"11","author":"Zou","year":"2021","journal-title":"J Glob Health."},{"key":"B58","unstructured":"Implementation Rules for the Evaluation Standards of Tertiary General Hospitals, 2011 Edition (in Chinese)\n          \n          \n            \n              PRC\n            \n          \n          \n          2011"},{"key":"B59","doi-asserted-by":"publisher","first-page":"e034414","DOI":"10.1136\/bmjopen-2019-034414","article-title":"Public satisfaction with the healthcare system in China during 2013\u20132015: a cross-sectional survey of the associated factors","volume":"10","author":"Zhang","year":"2020","journal-title":"BMJ Open."},{"key":"B60","unstructured":"Notice of the National Health Commission on the issuance of the \u201cThree-level Hospital Evaluation Standards (2022 Edition)\u201d and its implementation rules (in Chinese)\n          \n          \n          \n          2022"},{"key":"B61","unstructured":"China Healthcare Security Diagnosis Related Groups (CHS-DRG) Grouping and Payment Technical Specifications\n          \n          \n          \n          2019"},{"key":"B62","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1093\/inthealth\/ihu001","article-title":"Hospital ownership and drug utilization under a global budget: a quantile regression analysis","volume":"6","author":"Zhang","year":"2014","journal-title":"Int Health."},{"key":"B63","doi-asserted-by":"publisher","first-page":"1579","DOI":"10.3982\/QE935","article-title":"Quantile treatment effects in difference in differences models with panel data","volume":"10","author":"Callaway","year":"2019","journal-title":"Quant Econom."},{"key":"B64","doi-asserted-by":"publisher","first-page":"33","DOI":"10.2307\/1913643","article-title":"Regression quantiles","volume":"46","author":"Koenker","year":"1978","journal-title":"Economet J Economet Soc."},{"key":"B65","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/0034-6527.00321","article-title":"Semiparametric difference-in-differences estimators","volume":"72","author":"Abadie","year":"2005","journal-title":"Rev Econ Stud."},{"key":"B66","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1111\/j.1468-0262.2006.00668.x","article-title":"Identification and inference in nonlinear difference-in-differences models","volume":"74","author":"Athey","year":"2006","journal-title":"Econometrica."},{"key":"B67","unstructured":"Effect of separating treatment and drug sales: evidence form medical insurance claims data\n          \n          \n            \n              Chen\n              Z\n            \n            \n              Song\n              Z\n            \n            \n              Zhang\n              C\n            \n          \n          J Finan Res.\n          \n          2018"},{"key":"B68","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1080\/07350015.1995.10524589","article-title":"Natural and quasi-experiments in economics","volume":"13","author":"Meyer","year":"1995","journal-title":"J Bus Econ Statist."},{"key":"B69","first-page":"6796","article-title":"The impact of diagnosis related group payment on the performance of public hospitals","volume":"13","author":"Ma","year":"2021","journal-title":"Am J Transl Res"},{"key":"B70","doi-asserted-by":"publisher","first-page":"1069131","DOI":"10.3389\/fpubh.2023.1069131","article-title":"The impacts of diagnosis-intervention packet payment on the providers' behavior of inpatient care\u2014evidence from a national pilot city in China","volume":"11","author":"Ding","year":"2023","journal-title":"Frontiers in Public Health."},{"key":"B71","first-page":"1055","article-title":"Comparison of medical costs and care of appendectomy patients 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":"B72","doi-asserted-by":"publisher","first-page":"109","DOI":"10.5582\/bst.2017.01289","article-title":"Diagnosis-related group (DRG)-based case-mix funding system, a promising alternative for fee for service payment in China","volume":"12","author":"Zhao","year":"2018","journal-title":"Biosci Trends."},{"key":"B73","doi-asserted-by":"publisher","first-page":"114601","DOI":"10.1016\/j.socscimed.2021.114601","article-title":"Hospital response to a case-based payment scheme under regional global budget: the case of Guangzhou in China","volume":"292","author":"Lai","year":"2022","journal-title":"Soc Sci Med."},{"key":"B74","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.puhe.2024.04.021","article-title":"How does diagnosis-related group payment impact the health care received by rural residents?","volume":"232","author":"Xiang","year":"2024","journal-title":"Lesson Learn China Public Health."},{"key":"B75","unstructured":"Statistical Bulletin on the Development of the National Health Security Service, 2023\n          \n          \n          \n          2024"},{"key":"B76","doi-asserted-by":"publisher","first-page":"35","DOI":"10.6049\/kjjbydc.2019030395","article-title":"Trends and explanations of medical technology progress in China","volume":"37","author":"Qian","year":"2020","journal-title":"Sci Tech Progres Policy."},{"key":"B77","doi-asserted-by":"publisher","first-page":"944540","DOI":"10.3389\/fphar.2022.944540","article-title":"Changing characteristics of pharmaceutical prices in China under centralized procurement policy: a multi-intervention interrupted time series","volume":"13","author":"Long","year":"2022","journal-title":"Front Pharmacol."},{"key":"B78","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11096-024-01767-1","article-title":"Impact and implications of national centralized drug procurement in China","volume":"46","author":"Wang","year":"2024","journal-title":"Int J Clin Pharm."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1582001\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T04:14:45Z","timestamp":1755663285000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1582001\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":78,"alternative-id":["10.3389\/fpubh.2025.1582001"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1582001","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2025,8,20]]},"article-number":"1582001"}}