{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:07:40Z","timestamp":1788790060133,"version":"build-2803163510"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"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":"\n Background<\/jats:title>\n China's nationwide rollout of diagnosis-related group (DRG) bundled payment, implemented from January 2021, is one of the most consequential structural reforms to hospital reimbursement in recent decades. Total hip arthroplasty (THA)\u2014a high-volume, implant-intensive elective procedure with marked inter-institutional cost variation\u2014provides an analytically tractable context in which to evaluate whether fixed-payment incentives alter provider resource utilization while preserving clinical quality.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective longitudinal study included 2,621 consecutive THA admissions at a tertiary teaching hospital in Wenzhou, Zhejiang Province, between January 2015 and April 2026 (pre-DRG:\n n<\/jats:italic>\n = 1,041; post-DRG:\n n<\/jats:italic>\n = 1,580). Segmented linear regression with Newey\u2013West heteroscedasticity- and autocorrelation-consistent (HAC) standard errors was applied to 136 monthly aggregated observations (72 pre-intervention; 64 post-intervention). Primary outcomes were monthly mean total hospitalization cost, drug cost, and orthopedic implantable device cost. A composite adverse discharge outcome rate (in-hospital mortality, failure to achieve clinical improvement, and unclassified discharge) was the clinical quality endpoint. Four pre-specified sensitivity analyses addressed consumer price index (CPI) inflation adjustment, COVID-19\u2013related confounding (exclusion of 2020), Prais\u2013Winsten first-order autoregressive [AR(1)] correction, and case-mix adjustment for monthly patient age and sex composition.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Mean total hospitalization cost declined from CNY 53,476 \u00b1 14,898 to CNY 37,475 \u00b1 15,273 (\u221229.9%;\n p<\/jats:italic>\n &lt; 0.001). Orthopedic implantable device cost fell from CNY 35,826 \u00b1 9,607 to CNY 17,727 \u00b1 10,097 (\u221250.5%;\n p<\/jats:italic>\n &lt; 0.001), and drug cost from CNY 6,685 \u00b1 5,058 to CNY 5,741 \u00b1 3,311 (\u221214.1%;\n p<\/jats:italic>\n &lt; 0.001). Interrupted time series (ITS) modeling identified strong pre-existing downward trends in both total (\u03b2\n 1<\/jats:sub>\n = \u221289.79 CNY\/month;\n p<\/jats:italic>\n = 0.003) and device costs (\u03b2\n 1<\/jats:sub>\n = \u2212104.81 CNY\/month;\n p<\/jats:italic>\n = 0.001) prior to DRG implementation. Post-DRG slope changes for total and device costs did not reach statistical significance (\n p<\/jats:italic>\n = 0.071 and\n p<\/jats:italic>\n = 0.061, respectively). Drug cost exhibited a significant immediate level increase (\u03b2\n 2<\/jats:sub>\n = 3,006 CNY;\n p<\/jats:italic>\n = 0.003) followed by a statistically significant sustained monthly decline (\u03b2\n 3<\/jats:sub>\n = \u221227.80 CNY\/month;\n p<\/jats:italic>\n = 0.045). The composite adverse discharge rate did not differ significantly between periods (1.06% vs. 0.63%; \u03c7\n 2<\/jats:sup>\n = 0.944;\n p<\/jats:italic>\n = 0.334). Sensitivity analysis excluding 2020 yielded a statistically significant post-DRG slope change for total cost (\u03b2\n 3<\/jats:sub>\n = \u2212146.92 CNY\/month;\n p<\/jats:italic>\n = 0.047), suggesting that COVID-19\u2013related disruptions partially attenuated this effect in the primary analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Following DRG implementation, total and orthopedic implantable device costs continued their pre-existing downward trajectories, with observed expenditure sustained well below the pre-intervention counterfactual. The primary ITS analysis did not identify a statistically significant DRG-specific acceleration of this decline for total or device costs, a finding that predominantly reflects the dominant contribution of antecedent volume-based procurement reform. Drug cost exhibited the most clearly DRG-attributable effect\u2014an initial transitional surge followed by sustained statistically significant decline\u2014compatible with institutional adaptation after implementation of fixed-payment incentives. No evidence of in-hospital deterioration in adverse discharge outcomes was detected; this underpowered composite endpoint did not capture post-discharge events such as 30-day readmission or surgical-site infection.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1886645","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T05:28:03Z","timestamp":1787203683000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of diagnosis-related group\u2013based bundled payment on hospitalization costs and clinical outcomes in total hip arthroplasty: an interrupted time series analysis from Wenzhou, China"],"prefix":"10.3389","volume":"14","author":[{"given":"KeCheng","family":"Li","sequence":"first","affiliation":[{"name":"Quality Control Office, Ruian People's Hospital, Wenzhou","place":["Zhejiang, 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