Impact of DRG Payment Reform on Patients Undergoing Orthopedic Internal Fixation Surgery

Impact of DRG Payment Reform on Patients Undergoing Orthopedic Internal Fixation Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of DRG Payment Reform on Patients Undergoing Orthopedic Internal Fixation Surgery Shifei Wang, Yongcheng Liu, Zhenzhen Du, Xindie Zhou, Jiapei Yao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7974147/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objectives To evaluate the impact of the DRG payment reform on the hospitalization expenses, service efficiency, and expense structure of patients undergoing orthopedic internal fixation surgery. Methods A retrospective interrupted time-series analysis was conducted by including 720 patients who underwent orthopedic internal fixation surgery at a tertiary first-class hospital in Jiangsu Province (360 cases before the reform and 360 cases after the reform). Data from 2019 (before the reform) and 2022 (after the reform) were analyzed, using segmented regression models, new grey relational analysis, and structural variation analysis. The primary outcome indicators included total hospitalization expenses, the length of hospital stay, and changes in expense structure. Results After the DRG payment reform, medical efficiency improved significantly, with the average length of hospital stay declining from 12.44 days to 10.68 days (-14.15%, P = 0.010). However, there was no significant change in the average total hospitalization expense (decreasing from 27,071.09 yuan to 26,286.35 yuan, i.e., 2.90%, P = 0.688), while the medical insurance reimbursement expense increased slightly by almost 2.95%, indicating a significant reshaping of the structure of inpatient expenses. The most prominent change was a 61.88% increase in examination and test fees (P < 0.001). Medical service, drug, and consumable fees all showed a downward trend (decreasing by 10.88%, 13.21%, and 9.30%, respectively). However, none of these reached statistical significance (all P-values > 0.05). When stratified by age, the average cost per case decreased significantly in the 50‒59 and ≥ 60 years age groups, with 23.25% (P = 0.018) and 19.52% (P = 0.015), respectively. In terms of surgical complexity, the cost and length of hospital stay for grade IV complex surgeries showed the greatest improvement: cost decreased by 36.11% (P < 0.001) and length of hospital stay decreased by 27.24% (P = 0.003). Conclusion The DRG payment reform successfully improved medical efficiency and shifted the expense structure from a consumable- and drug-dependent to a diagnosis-driven model. The differential impacts of the reform on different age groups and surgical complexity levels suggest that the risk adjustment mechanism must be further refined. DRG payment reform Orthopedic surgery Hospitalization costs Interrupted time series Structural variation analysis Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 Dec, 2025 Reviewers agreed at journal 02 Dec, 2025 Reviewers invited by journal 30 Nov, 2025 Editor invited by journal 06 Nov, 2025 Editor assigned by journal 06 Nov, 2025 Submission checks completed at journal 06 Nov, 2025 First submitted to journal 28 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7974147","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":553064761,"identity":"34f84b3b-03a0-4872-8f02-c19af2280d86","order_by":0,"name":"Shifei Wang","email":"","orcid":"","institution":"Changzhou University","correspondingAuthor":false,"prefix":"","firstName":"Shifei","middleName":"","lastName":"Wang","suffix":""},{"id":553064765,"identity":"4ce6a2d5-52d8-4b82-a247-45677e80b897","order_by":1,"name":"Yongcheng Liu","email":"","orcid":"","institution":"Changzhou 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Surgery","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"DRG payment reform, Orthopedic surgery, Hospitalization costs, Interrupted time series, Structural variation analysis","lastPublishedDoi":"10.21203/rs.3.rs-7974147/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7974147/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eTo evaluate the impact of the DRG payment reform on the hospitalization expenses, service efficiency, and expense structure of patients undergoing orthopedic internal fixation surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective interrupted time-series analysis was conducted by including 720 patients who underwent orthopedic internal fixation surgery at a tertiary first-class hospital in Jiangsu Province (360 cases before the reform and 360 cases after the reform). Data from 2019 (before the reform) and 2022 (after the reform) were analyzed, using segmented regression models, new grey relational analysis, and structural variation analysis. The primary outcome indicators included total hospitalization expenses, the length of hospital stay, and changes in expense structure.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAfter the DRG payment reform, medical efficiency improved significantly, with the average length of hospital stay declining from 12.44 days to 10.68 days (-14.15%, P\u0026thinsp;=\u0026thinsp;0.010). However, there was no significant change in the average total hospitalization expense (decreasing from 27,071.09 yuan to 26,286.35 yuan, i.e., 2.90%, P\u0026thinsp;=\u0026thinsp;0.688), while the medical insurance reimbursement expense increased slightly by almost 2.95%, indicating a significant reshaping of the structure of inpatient expenses. The most prominent change was a 61.88% increase in examination and test fees (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Medical service, drug, and consumable fees all showed a downward trend (decreasing by 10.88%, 13.21%, and 9.30%, respectively). However, none of these reached statistical significance (all P-values\u0026thinsp;\u0026gt;\u0026thinsp;0.05). When stratified by age, the average cost per case decreased significantly in the 50‒59 and \u0026ge;\u0026thinsp;60 years age groups, with 23.25% (P\u0026thinsp;=\u0026thinsp;0.018) and 19.52% (P\u0026thinsp;=\u0026thinsp;0.015), respectively. In terms of surgical complexity, the cost and length of hospital stay for grade IV complex surgeries showed the greatest improvement: cost decreased by 36.11% (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and length of hospital stay decreased by 27.24% (P\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe DRG payment reform successfully improved medical efficiency and shifted the expense structure from a consumable- and drug-dependent to a diagnosis-driven model. The differential impacts of the reform on different age groups and surgical complexity levels suggest that the risk adjustment mechanism must be further refined.\u003c/p\u003e","manuscriptTitle":"Impact of DRG Payment Reform on Patients Undergoing Orthopedic Internal Fixation Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 22:56:17","doi":"10.21203/rs.3.rs-7974147/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-12T03:54:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230535714103144861313004348978488205849","date":"2025-12-02T17:07:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-01T00:42:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-06T18:29:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-06T06:18:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-06T06:16:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-10-28T23:38:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2bd53e20-7132-4d54-a348-3a57782f93b2","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-02T22:56:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 22:56:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7974147","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7974147","identity":"rs-7974147","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}