{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:59:53Z","timestamp":1790312393987,"version":"4.1.0"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"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>Background<\/jats:title>\n                    <jats:p>Under China\u2019s Diagnosis-Related Group (DRG) prospective payment system, hospitals bear the financial risk of costs that exceed the fixed reimbursement standard, making case-level cost distribution and the probability of loss critical to departmental sustainability for high-volume, low-complexity procedures such as laparoscopic cholecystectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>However, the probability distribution of hospitalization costs and the quantitative financial risk faced by a single institution operating under a fixed DRG payment standard for the group HS10B (laparoscopic cholecystectomy without common bile duct exploration) remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single-center study included 475 consecutive patients who underwent laparoscopic cholecystectomy (surgery code 51.2300) for gallbladder polyps (DRG group HS10B) over a five-year period (2020\u20132024; annual case volume ranged from 50 to 136). Total hospitalization cost, medication cost, and material cost were extracted; other cost was derived as total cost minus medication cost minus material cost. Distributional properties were characterized using Kolmogorov\u2013Smirnov normality testing and comparative fitting of normal, log-normal, and Gamma distributions (Akaike information criterion [AIC] and goodness-of-fit testing). Monte Carlo simulation (20,000 iterations), combining parametric resampling from the fitted Gamma distribution and non-parametric bootstrap resampling of the observed cohort, was used to estimate the probability distribution of case-level and aggregate financial margin relative to the local DRG reimbursement standard of \u00a512,592.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean total hospitalization cost was \u00a510,293.17 (SD 1,442.22; median \u00a510,263.40, IQR \u00a59,258.10\u201311,174.65), which was right-skewed (skewness 0.54) and best represented by a Gamma distribution (Kolmogorov\u2013Smirnov\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.819). Twenty-two of 475 cases (4.63%) incurred costs exceeding the \u00a512,592 breakeven threshold. Monte Carlo simulation estimated a mean per-case margin of \u00a52,302.55 (95% simulation interval, \u2212\u00a5686.76 to \u00a54,928.44) and a case-level loss probability of 6.2%. Bootstrap resampling of the observed cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f475) projected a mean aggregate margin of \u00a51,091,888 (95% CI \u00a51,029,920\u20131,153,715), with no net cohort-level loss observed among the 20,000 simulated resamples (upper one-sided 95% bound, 0.015%); an annual projection assuming 95 cases\/year yielded a mean annual margin of \u00a5218,354 (95% CI \u00a5190,780\u2013245,908), again with no simulated annual loss (upper bound, 0.015%); results were consistent when total cost was modeled as log-normal instead of Gamma. Total cost differed significantly across admission year (Kruskal\u2013Wallis\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), declining from a mean of \u00a510,172 in 2020 to \u00a59,329 in 2024, with the empirical case-level loss rate falling correspondingly from 7.4 to 0% over the same interval.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Inpatient cost for HS10B laparoscopic cholecystectomy follows a right-skewed distribution adequately described by a Gamma model; in this single-center cohort, case-specific cost volatility at the individual level was accompanied by a positive aggregate margin at the departmental level, consistent with a risk-pooling effect at this case volume. Hospital administrators should transition from conventional mean-centric accounting toward distribution-aware financial surveillance to better anticipate tail risk under prospective payment systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1974837","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:26:45Z","timestamp":1790310405000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost distribution and Monte Carlo simulation of financial risk under DRG-based prospective payment for laparoscopic cholecystectomy in patients with gallbladder polyps: a single-center retrospective study"],"prefix":"10.3389","volume":"14","author":[{"given":"KeCheng","family":"Li","sequence":"first","affiliation":[{"name":"Quality Control Office, Ruian People\u2019s Hospital","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiaoChan","family":"Xiang","sequence":"additional","affiliation":[{"name":"Quality Control Office, Ruian People\u2019s Hospital","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiwei","family":"Zeng","sequence":"additional","affiliation":[{"name":"Quality Control Office, Ruian People\u2019s Hospital","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ge","family":"Li","sequence":"additional","affiliation":[{"name":"Quality Control Office, Ruian People\u2019s Hospital","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JianWu","family":"Shi","sequence":"additional","affiliation":[{"name":"Quality Control Office, Ruian People\u2019s Hospital","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiaoLi","family":"Gao","sequence":"additional","affiliation":[{"name":"Quality Control Office, Ruian People\u2019s Hospital","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"QianWen","family":"Ye","sequence":"additional","affiliation":[{"name":"Quality Control Office, Ruian People\u2019s Hospital","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Xu","sequence":"additional","affiliation":[{"name":"Quality Control Office, Ruian People\u2019s Hospital","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Quality Control Office, Ruian People\u2019s Hospital","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZhangChen","family":"Wu","sequence":"additional","affiliation":[{"name":"Quality Control Office, Ruian People\u2019s Hospital","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.12701\/yujm.2020.00213","article-title":"Gallbladder polyps: evolving approach to the diagnosis and management","volume":"38","author":"Kim","year":"2020","journal-title":"Yeungnam Univ J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e16113","DOI":"10.7759\/cureus.16113","article-title":"Surveillance of gallbladder polyps: a literature review","volume":"13","author":"Kalbi","year":"2021","journal-title":"Cureus"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"4526","DOI":"10.3748\/wjg.v19.i28.4526","article-title":"Gallbladder 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A comparative study based on the implementation of the DRG payment","author":"Du","year":"2025","journal-title":"arXiv."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1364116","DOI":"10.3389\/fpubh.2025.1364116","article-title":"Impact of zero-markup consumable policy and national procurement of coronary stents on hospitalization expenses: an interrupted time series analysis","volume":"13","author":"Wu","year":"2025","journal-title":"Front Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s13561-015-0045-7","article-title":"Statistical models for the analysis of skewed healthcare cost data: a simulation study","volume":"5","author":"Malehi","year":"2015","journal-title":"Health Econ Rev"},{"key":"ref13","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":"ref14","doi-asserted-by":"publisher","first-page":"20231261","DOI":"10.1098\/rspb.2023.1261","article-title":"Practical advice on variable selection and reporting using Akaike information criterion","volume":"290","author":"Sutherland","year":"2023","journal-title":"Proc R Soc B"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"6924","DOI":"10.1007\/s00464-025-12051-2","article-title":"Concomitant laparoscopic cholecystectomy with bariatric surgery: current insights from the 2015-2021 MBSAQIP database","volume":"39","author":"Rouhi","year":"2025","journal-title":"Surg Endosc"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1974837\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:26:46Z","timestamp":1790310406000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1974837\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":15,"alternative-id":["10.3389\/fpubh.2026.1974837"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1974837","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"1974837"}}