The effects of DRGs-based payment compared with cost-based payment on inpatient healthcare utilization: A systematic review and meta-analysis

• Published in: Health policy (Amsterdam) 2020-04, Vol.124 (4), p.359-367
• Main Authors: Meng, Zhaolin, Hui, Wen, Cai, Yuanyi, Liu, Jiazhou, Wu, Huazhang
• Format: Article
• Language: English
• Subjects: Analysis; Cost-based payment; Data quality; Diagnosis related groups; DRGs; Health administration; Health care expenditures; Health services; Health services utilization; Heterogeneity; Hospital costs; Hospitalization; Inpatient care; Inpatient healthcare utilization; Length of stay; Medical diagnosis; Meta-analysis; Patient admissions; Policy making; Quality assessment; Random effects; Readmission; Systematic review
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2020.01.007

•Diagnosis related groups (DRGs) based payment is increasingly used worldwide.•Meta-analysis showed that DRGs-based payment was associated with lower length of stay.•Meta-analysis showed that DRGs-based payment was associated with higher readmission rates.•The links between DRGs-based payment and inpatient health utilization were uncertain. Diagnosis related groups (DRGs)-based payment is increasingly used worldwide to control hospital costs instead of pre-existing cost-based payment, but the results of evaluations vary. A systematic analysis of the effects of DRGs-based payment is needed. This study aims to conduct a systematic review and meta-analysis to compare the effects of DRGs-based payment and cost-based payment on inpatient health utilization in terms of length of stay (LOS), total inpatient spending per admission and readmission rates. We included studies undertaken with designs approved by the Cochrane Effective Practice and Organisation of Care that reported associations between DRGs-based payment and one or more inpatient healthcare utilization outcomes. After a systematic search of eight electronic databases through October 2018, 18 studies were identified and included in the review. We extracted data and conducted quality assessment, systematic synthesis and meta-analyses on the included studies. Random-effects models were used to handle substantial heterogeneity between studies. Meta-analysis showed that DRGs-based payment was associated with lower LOS (pooled effect: -8.07 % [95 %CI -13.05 to -3.10], p = 0.001), and higher readmission rates (pooled effect: 1.36 % [95 %CI 0.45–2.27], p = 0.003). This meta-analysis revealed that DRGs-based payment may have cost-saving implications by lowering LOS, whereas hardly reduce the readmission rates. Policy-makers considering adopting DRGs-based payment should pay more attention to the hospital readmission rates compared with cost-based payment.