{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:04:54Z","timestamp":1789621494380,"version":"build-2803163510"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"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 has rapidly expanded its diagnosis-related group (DRG)-based payment reform; however, evidence primarily focuses on urban pilots or specific disease cohorts. There is limited understanding of how DRG implementation affects out-of-pocket (OOP) spending, cost composition, and resource utilization among older adults treated in county-level referral hospitals.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a retrospective interrupted time series study utilizing administrative inpatient data from a tertiary county-level referral hospital in eastern China. From July 1, 2021, to July 31, 2025, we identified 154,744 admissions among adults aged \u226560. The outcomes assessed included total costs, out-of-pocket costs, drug costs, material costs, examination\/laboratory costs, and length of stay (LOS). The primary analysis used admission-level segmented regression with standard errors clustered by calendar month. Supplementary analyses used monthly aggregated models with Newey-West standard errors and exploratory disease-group heterogeneity analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In the adjusted admission-level interrupted time series models, the implementation of DRG was associated with an immediate reduction in OOP costs (\n \u03b2<\/jats:italic>\n 2<\/jats:sub>\n \u202f=\u202f\u22121360.617 CNY) and a more pronounced negative trend post-implementation (\n \u03b2<\/jats:italic>\n 3<\/jats:sub>\n \u202f=\u202f\u2212106.705 CNY per month). LOS experienced an immediate increase (\n \u03b2<\/jats:italic>\n 2<\/jats:sub>\n \u202f=\u202f0.831\u202fdays) and continued to rise in comparison to the pre-implementation trend (\n \u03b2<\/jats:italic>\n 3<\/jats:sub>\n \u202f=\u202f0.077\u202fdays per month). Total-cost findings differed by the analytical level: no statistically significant immediate or slope change was observed in the admission-level model (\u03b2\u2082\u202f=\u202f\u221284.683 CNY; \u03b2\u2083\u202f=\u202f34.844 CNY\/month), whereas the monthly aggregated model showed an immediate decrease (\u03b2\u2082\u202f=\u202f\u2212851.064 CNY) followed by an upward post-intervention slope change (\u03b2\u2083\u202f=\u202f75.090 CNY\/month). Changes in total costs and most cost components were not consistent across different model specifications. Monthly aggregated analyses indicated directionally similar results for OOP costs and LOS. Disease-group analyses revealed that reductions in OOP costs were more substantial for neoplasms, digestive diseases, and circulatory diseases, while increases in LOS were primarily observed in certain circulatory and respiratory conditions.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Among older adult inpatients in a county-level referral hospital in China, DRG-based payment reform was associated with lower patient OOP but longer hospital stays. Its effects on total spending and cost composition were less consistent and varied across disease groups.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1953054","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:47:14Z","timestamp":1789620434000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of DRG-based payment reform with inpatient costs and resource use among older adults: an interrupted time series study in a county-level referral hospital in China"],"prefix":"10.3389","volume":"14","author":[{"given":"Jiacheng","family":"Zou","sequence":"first","affiliation":[{"name":"School of Health Management, Anhui Medical University","place":["Hefei, Anhui, China"]},{"name":"School of Public Health, Southeast University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shumin","family":"Wang","sequence":"additional","affiliation":[{"name":"Hefei Third People's Hospital","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiali","family":"Shi","sequence":"additional","affiliation":[{"name":"YiXing People\u2019s Hospital","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhan","family":"Chen","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Guan","sequence":"additional","affiliation":[{"name":"The Fourth Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaohua","family":"Li","sequence":"additional","affiliation":[{"name":"School of Health Management, Anhui Medical University","place":["Hefei, Anhui, China"]},{"name":"Anhui Provincial Institute of Healthcare Security, Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1016\/S0140-6736(19)32136-1","article-title":"10 years of health-care reform in China: progress and gaps in universal health coverage","volume":"394","author":"Yip","year":"2019","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e002086","DOI":"10.1136\/bmjgh-2019-002086","article-title":"Towards universal health coverage: lessons from 10 years of healthcare reform in China","volume":"5","author":"Tao","year":"2020","journal-title":"BMJ Glob Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"l2358","DOI":"10.1136\/bmj.l2358","article-title":"Strengthening public health services to achieve universal health coverage in China","volume":"365","author":"Yuan","year":"2019","journal-title":"BMJ"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e003570","DOI":"10.1136\/bmjgh-2020-003570","article-title":"Ten years of progress towards universal health coverage: has China achieved equitable healthcare financing?","volume":"5","author":"Chen","year":"2020","journal-title":"BMJ Glob Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1093\/heapol\/czab050","article-title":"Effectiveness of hospital payment reforms in low- and middle-income countries: a systematic review","volume":"36","author":"Ghazaryan","year":"2021","journal-title":"Health Policy Plan"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"104990","DOI":"10.1016\/j.healthpol.2023.104990","article-title":"The end of an era? 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