{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T09:15:55Z","timestamp":1788254155670,"version":"build-2803163510"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"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>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Diagnosis-related group reform aims to restrain inpatient spending, but obstetric evaluations commonly emphasize average hospital costs rather than insurance-specific patient cost sharing. We evaluated early discontinuities associated with CHS-DRG 2.0 in hospitalization costs, out-of-pocket (OOP) payment, self-pay ratio, and selected perinatal outcomes among gestational diabetes mellitus (GDM) admissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 8,690 singleton GDM delivery admissions at a tertiary maternal and child health hospital in Fujian, China. The main cohort excluded eight stays exceeding 60\u202fdays, consistent with the policy DRG-management scope. We classified policy period from the recorded admission date under the provincial rule: admissions before 1 January 2025, including cross-cutoff stays, remained under the prior payment arrangement; admissions on or after that date entered the CHS-DRG 2.0 policy period. Actual DRG assignment and claim settlement were unavailable. Local linear regression discontinuity in time models used triangular kernels, data-driven bandwidths, robust bias-corrected confidence intervals, and discharge-day-clustered standard errors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The admission-date cutoff was not associated with a precise discontinuity in total hospitalization cost (estimate, \u221242.10 CNY; 95% CI, \u22121,158.46 to 1,074.26;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.941), OOP payment (\u2212102.15 CNY; 95% CI, \u22121,289.55 to 1,085.25;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.866), or overall self-pay ratio (\u22122.75 percentage points; 95% CI, \u22128.06 to 2.56;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.310). The self-pay ratio declined among resident-insured admissions (\u221212.41 percentage points; 95% CI, \u221220.05 to \u22124.77;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001), but not employee-insured admissions (\u22120.33 percentage points; 95% CI, \u22125.79 to 5.13;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.905). The interaction estimate was \u221211.99 percentage points (95% CI, \u221219.85 to \u22124.13;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.003). No exploratory perinatal outcome remained significant after false-discovery-rate correction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The admission-date policy boundary was associated with a larger reduction in relative patient cost sharing among resident-insured GDM admissions. Discontinuous admission density at the cutoff and possible concurrent calendar-time changes limit causal attribution and preclude inference about a specific payment mechanism. Payment-reform evaluations should jointly assess insurance-specific patient cost sharing, provider expenditure, and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1939491","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T08:30:20Z","timestamp":1788251420000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["CHS-DRG 2.0 and insurance-specific patient cost sharing in gestational diabetes admissions: a regression discontinuity in time study"],"prefix":"10.3389","volume":"14","author":[{"given":"Senhua","family":"Chen","sequence":"first","affiliation":[{"name":"Fujian Maternity and Child Health Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shen","family":"Huang","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Lan","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"771","DOI":"10.21037\/hbsn-2020-8","article-title":"Diagnosis-related groups (DRG) pricing and payment policy in China: where are we?","volume":"9","author":"Yu","year":"2020","journal-title":"Hepatobiliary Surg Nutr"},{"key":"ref2","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":"ref3","doi-asserted-by":"publisher","first-page":"f3197","DOI":"10.1136\/bmj.f3197","article-title":"Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals?","volume":"346","author":"Busse","year":"2013","journal-title":"BMJ"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1007\/s11154-025-09987-0","article-title":"Trends in gestational diabetes prevalence in China from 1990 to 2024: a systematic review and meta-analysis","volume":"26","author":"Wu","year":"2025","journal-title":"Rev Endocr Metab Disord"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.3390\/healthcare12191905","article-title":"Gestational outcomes related to the occurrence of gestational diabetes mellitus: a cohort study","volume":"12","author":"Souza 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