The Effects of DRG Payment on Inpatient Costs for Hip Fracture Patients: Evidence from a Tertiary Hospital in China

The Effects of DRG Payment on Inpatient Costs for Hip Fracture Patients: Evidence from a Tertiary Hospital in China | 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 The Effects of DRG Payment on Inpatient Costs for Hip Fracture Patients: Evidence from a Tertiary Hospital in China Mian Xia, Handan Wang, Mingou Wang, Xuan Luo, Ying Zhang, Qiang Yao, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9113175/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Diagnosis related groups payment (DRG) is a key policy for controlling medical insurance costs in China. Hip fracture, a typical disease with high disease burden and resource consumption, serves as a key window to evaluate the effectiveness of DRG reform, but its response to the reform has not been fully verified. This study aims to clarify the effects of DRG payment reform on inpatient costs and the cost structure of hip fracture patients, providing empirical evidence for policy optimization. Method Data on 5,385 hospitalized patients with hip fractures were retrospectively obtained from medical insurance claims data of a tertiary hospital in China from 2019 to 2023, using 2020 as the time point. This study employs a difference-in-differences (DID) model to assess the DRG policy’s effects on cost-control, supplemented by robustness tests and heterogeneity analyses. Results The results show that after the DRG implementation, the total inpatient costs for hip fracture patients decreased significantly by 4.3% (p < 0.001), the proportion of drug costs dropped by 1.1% (p < 0.001), and the proportion of medical costs and technical costs, respectively, increased by 0.6% (p < 0.001) and 1.1% (p < 0.001). Male, non-older adult, outpatient-admitted, surgically treated, complication-free, and normal-rate cases were the core beneficiaries, with significant reductions in total inpatient costs, drug costs, and material costs. However, the cost control effect was insufficient for female, older adult patients, and high/low-rate cases. Conclusions The DRG payment reform has preliminarily controlled the cost and optimized the expense structure for hip fracture inpatients. Given the heterogeneity of its cost-control effects, future policy implementation should take into account the characteristics of different patient groups and case types to expand the positive policy effects of DRG. Diagnosis-Related Group (DRG) inpatient costs cost structure hip fracture Figures Figure 1 Figure 2 1 Introduction Health expenditures have skyrocketed due to the aging population, increasingly complex illness patterns, rising medical demand, and structural imbalances in medical resources, which creates a major global challenge [ ] . In 2024, China’s current health expenditures reached almost 9.09 trillion yuan (nearly US $ 1.30 trillion), accounting for 6.7% of GDP [ ] . The excessively rapid growth in health expenses has placed a severe economic burden on individuals and governments, threatening the sustainability of China’s social health insurance funds. Therefore, how to control the health expenditures and enhance the efficiency of medical insurance fund utilization while ensuring medical quality has emerged as an urgent priority. Globally, various payment reforms have been explored to optimize medical resource allocation, control medical costs, and enhance service quality. By adjusting incentive mechanisms, these reforms aim to standardize clinical practices, improve the efficiency of insurance fund utilization, and restrain the irrational growth of medical expenditures [ ] . The transition from retrospective fee-for-service (FFS) payment to prospective Diagnosis-Related Groups (DRG) payment has become a prevailing trend in medical insurance reform [ ] . The DRG payment classifies patients into similar case groups based on diagnosis, treatment approaches and clinical procedures, calculates the average cost for each group, and establishes corresponding payment standards [ ] . Its core objective is to encourage hospitals to optimize resource allocation while promoting the quality and efficiency of medical service delivery. Existing studies have demonstrated that DRG payment can yield expected outcomes such as reduction in medical expenditures and adjustments in service quality and efficiency. However, research conclusions remain inconsistent across different countries, regions, hospital types and levels [ ][ ] , disease categories [ ] , expense types [ ] , and initial payment systems [ ][ ] . Studies on DRG payment’s effects on medical expenditures employ a wide range of study designs, including single-center or multi-center, national or regional, and multi-disease or specialized disease analyses. The cost-control effect of the DRG system has been supported by empirical analyses, attributed to its transparency and fixed-rate characteristics [ ][ ] . As a major component of medical expenditures [ ] , inpatient costs have garnered significant attention in DRG-related research. For instance, a study conducted in Beijing found that the transition from FFS to DRG reduced inpatient costs and patients’ out-of-pocket payment ratios by 6.2% and 10%, respectively [ ] . Evidence from Xiangtan, a city in China, indicated that DRG payment significantly lowered various inpatient costs, including medical costs and drug costs [7] . Conversely, an empirical study from Fujian Province reported no substantial decrease in inpatient costs for older hip fracture patients (aged 60 and above) after DRG implementation [ ] . Similar contradictory conclusions have also been reported in South Korea [ ] , Thailand [ ] , and other regions, indicating that effects of DRG payment on inpatient expenditures varies by region and disease type, and a consensus on its actual effects has yet to be reached. Furthermore, the majority of existing literature focuses on total inpatient costs at institutional or regional levels, employing quantitative methods to assess changes before and after DRG payment method reform. There remains a paucity of studies on specific diseases, especially high-burden conditions, as well as rigorous analyses of cost structure. More empirical studies are, therefore, required to evaluate the cost-control effects of DRG payment reform in China. As a typical high-burden disease, hip fracture refers to fractures within 5 cm of the femoral head and distal lesser trochanter. Predominantly affecting the older adults, hip fracture is caused by factors such as falls and osteoporosis, characterized by hip pain and limited mobility [ ] . It represents the most common and severe type of all fractures, accounting for approximately 23.79% of all fractures in Chinese older adults [ ] , with an annual incidence rate of 1.1% to 3.8% in China [ ] . The global hip fracture cases are projected to increase by 300,000 per year after 2030, reaching 6.26 million by 2050 [ ] . Hip fractures are clinically distinguished by high incidence, complication rates, disability rates, and mortality rates [ ] . Approximately 40% of older adult patients lose the ability to walk independently following a hip fracture, 60% require assistive devices for ambulation, and 33% fully lose self-care abilities within one year [ ] . Surgical treatment remains the most recommended procedure, as conservative treatment is associated with a 3–4 times higher mortality rate compared to surgical treatment [ ] . Orthopedic surgeries for hip fractures have distinct characteristics: unlike other high-weight diseases such as lung cancer and gastric cancer, they require the implantation of high-value consumables, along with meticulous nursing care and medication to prevent infection. Previous studies reveal that hip fractures place a significant financial burden on healthcare systems and patients. The global treatment expenditures related to hip fractures among older adults were around US $ 34.8 billion in 1990 [ ] , and are predicted to rise to US $ 131 billion per year by 2050 [ ] . Considering its high DRG weight, significant resource consumption, and significant cost volatility, hip fracture serves as a representative indicator for evaluating DRG’s cost-saving effects. Given the above background, this study focuses on the inpatient medical records of hip fracture patients at a tertiary hospital in China from 2019 to 2023, analyzing the changes in inpatient expenditures for hip fracture patients before and after the DRG implementation, in order to explore the regulatory effects of DRG payment reform on inpatient expenditures and its structure for high-burden diseases. Since 1 January 2020, the hospital has completely implemented DRG payment for all social medical insurance patients. The hospital selected for this study is a leading Grade-A tertiary hospital in Hangzhou, the provincial capital of Zhejiang Province, China. With abundant medical records that span patients from multiple cities across Zhejiang and neighboring provinces, it provides an ideal setting for our study. 2 Methods 2.1 Data Sources and Variable Definitions This study retrieved clinical and medical insurance claims data for all patients with hip fracture admitted to a tertiary hospital in Zhejiang Province from 1 January 2019 to 31 December 2023. The following data are retrieved: (1) Demographic characteristics of patients, including gender, age, treatment methods, outcomes, admission route, and case type; (2) Medical expenditure amount, including the amount of total inpatient costs and each component. Following the approach developed by Wang et al. (2025) [ ] , expenses were specifically divided into medical service costs, technical service costs, drug costs, and material costs. We included inpatient patients who had a primary diagnosis of hip fracture and complete key information. Hip fractures in this study were mainly defined as femoral neck fractures, intertrochanteric fractures, and subtrochanteric fractures, with corresponding International Classification of Diseases (ICD-10) diagnostic codes (S72.0, S72.1, S72.2, T93.101, T93.102, T93.107). Patients with extreme values in total inpatient expenditures were excluded. Ultimately, 5,385 patients were included in the study sample. Medical insurance patients subject to DRG payment were classified as the treatment group (n = 3,885, accounting for 72.14% of the total sample), while self-paying patients who were not affected by the DRG payment reform during the same period served as the control group (n = 1,500, accounting for 27.86% of the total sample). This hospital implemented DRG payment reform in 2020, which was designated as the policy intervention time point. Variables used in the study are presented in Table 1 . Table 1 Dependent variables, independent variables and control variables Type Name Abbreviation Measurement Method Dependent Variable Total inpatient costs total_cost Total medical costs incurred during the patient's hospitalization Medical service costs medical_cost Treatment costs, diagnosis costs, surgical costs, nursing costs, anesthesia costs, and blood transfusion costs incurred Technical service costs technical_cost Examination costs and laboratory costs incurred Drug costs drug_cost Total drug costs incurred Material costs material_cost Total material costs incurred Ratio of medical service costs medicost_ratio Ratio of medical service cost to total inpatient cost Ratio of technical service costs technicost_ratio Ratio of technical service cost to total inpatient cost Ratio of drug costs drugcost_ratio Ratio of drug cost to total inpatient cost Ratio of material costs matericost_ratio Ratio of material cost to total inpatient cost Independent Variable Policy group treat Control group = 0, Policy group = 1 Time group time Before DRG = 0, After DRG = 1 Net policy effect Did(treat*time) Interaction term between treat group and time Control Variable Gender gender Male = 0, Female = 1 Age age Patient's age Operation operation Non-surgical = 0, Surgical = 1 Clinical outcome clinical_outcome Unimproved or deceased = 0, Improved or cured = 1 Admission route admission_route Outpatient = 0, Emergency = 1 Case type case_type Low rate = 1, Normal rate = 2, High rate = 3 2.2 Statistical Analysis Continuous data (total inpatient costs, medical service costs, technical service costs, drug costs, and material costs) were converted to log form and reported as medians. The proportions of various costs were expressed as mean ± standard deviation. Categorical data (gender, age group, operation, clinical outcome, admission route, and disease type) are expressed as frequency (percentage). A two-tailed test with p < 0.05 is considered statistically significant. Statistical analyses were conducted using Excel 2019 and Stata 15.0. 2.2.1 Difference-in-Differences (DID) Model This study constructed a difference-in-differences (DID) model to assess changes in hip fracture patients’ inpatient expenditures before and after DRG payment reform, while controlling for confounding variables such as time trends and disease classification. By creating an interaction term between “treatment” and “time point”, the DID model calculates the changes in medical expenditures of the treatment group and the control group before and after policy implementation, with the difference between these changes representing the net effects of the DRG reform on expenditures [ ] . The following DID model was formulated: $$\:{\text{Y}}_{\text{i}\text{t}}={{\beta\:}}_{0}+{{\beta\:}}_{1}{\times\:\text{t}\text{r}\text{e}\text{a}\text{t}}_{\text{i}}+{{\beta\:}}_{2}\times\:{\text{t}\text{i}\text{m}\text{e}}_{\text{t}}+{{\beta\:}}_{3}\times\:\left({\text{t}\text{r}\text{e}\text{a}\text{t}}_{\text{i}}\times\:{\text{t}\text{i}\text{m}\text{e}}_{\text{t}}\right)+\sum\:{\lambda\:}{\text{X}}_{\text{i}\text{t}}+{+\text{ϵ}}_{\text{i}\text{t}}$$ Wherein, the dependent variable \(\:{\text{Y}}_{\text{it}}\) represents total inpatient costs, medical service costs, technical service costs, drug costs, material costs, and their respective proportions. Considering the skewed distribution of medical costs, the natural logarithm of each cost indicator was taken. The independent variables \(\:\text{trea}{\text{t}}_{\text{i}}\) and \(\:\text{tim}{\text{e}}_{\text{t}}\) represented the grouping dummy variable and time dummy variable before and after the DRG policy, respectively. \(\:\text{trea}{\text{t}}_{\text{i}}\text{×}\text{tim}{\text{e}}_{\text{t}}\) is the interaction term of our interest. \(\:\sum\:\lambda\:{X}_{it}\) represents control variables in Table 1 to exclude interference of non-policy factors on inpatient costs. In addition, \(\:{\text{ϵ}}_{\text{it}}\) is the random error term; \(\:{\text{β}}_{\text{0}}\) is the constant term (intercept); \(\:{\text{β}}_{\text{1}}\) and \(\:{\text{β}}_{\text{2}}\) represents the DRG effect and time fixed effect coefficients, respectively; \(\:{\text{β}}_{\text{3}}\) represents the net effect of the DRG policy on inpatient expenditures for hip fracture patients. This model also controlled for year-fixed effects and disease-grouping-fixed effects. 2.2.2 Robust Test To ensure the unbiasedness of the estimated DID coefficient, this assumption requires parallel pre-intervention trends between the treatment group and control group, with no statistically significant differences observed prior to the DRG implementation [ ] . This study used an ex-ante evaluation technique for parallel trend testing following Roth et al. (2023) [ ] . The parallel trend test graph presents quarterly data for 2019, a pre-implementation period of the DRG payment reform. The parallel trend assumption is satisfied if the 95% confidence interval (CI) of the coefficient includes 0 for all periods; otherwise, the coefficient is statistically significant, and the test fails. To further rule out the effects of additional unobservable and random factors on the baseline regression results, this study additionally performed a placebo test to ensure their robustness. Following Chay & Greenstone (2003) [ ] , if the observed effects in benchmark regression were caused by the DRG payment reform, the policy effects simulated by randomly generating policy implementation time points should not be statistically significant. 3 Results 3.1 Basic Characteristics of Hip Fracture Patients A total of 5,385 clinical cases of hip fracture patients were included in this study, with 3,885 in the treatment group and 1,500 in the control group. Their demographics and clinical characteristics are presented in Table 2 . Females accounted for 68.08% of the treatment group and 54.93% of the control group, with a higher proportion of females than males in both groups. This aligns with the higher incidence of osteoporosis in females seen in clinical practice, indicating that females are at a higher risk of hip fracture. Older adult patients aged 65 and above numbered 3,203 in the treatment group and 792 in the control group, confirming that the hip fracture incidence is significantly concentrated in the older adults. The vast majority of patients in both groups underwent surgery, consistent with the clinical principle of early surgical intervention for hip fractures to restore function and prevent bedridden complications. Overall, 98.10% and 97.93% of patients in the treatment and control groups, respectively, achieved clinical improvement following surgery or other hospital procedures. Regarding the admission route, the emergency admission rate exceeded 80% in two groups, indicating that hip fracture was frequently caused by accidental occurrences such as falls, resulting in an acute onset and severe condition requiring immediate medical attention. In terms of case type, normal cases accounted for 90% in the two groups, indicating that most hip fracture costs fall within the DRG payment threshold. Table 2 Baseline Characteristics of Patients with Hip Fracture Variables Treat = 1(n = 3,885) Treat = 0(n = 1,500) Number Percentage(%) Number Percentage(%) Gender Male 1,240 31.92 676 45.07 Female 2,645 68.08 824 54.93 Age ≤ 64 682 17.55 708 47.20 65–79 1,363 35.08 462 30.80 ≥ 80 1,840 47.36 330 22.00 Operation Non-surgical 156 4.02 58 3.87 Surgical 3,729 95.98 1,442 96.13 Clinical outcome Unimproved/Deceased 74 1.90 31 2.07 Improved/Cured 3,811 98.10 1,469 97.93 Admission route Outpatient 598 15.39 245 16.33 Emergency 3,287 84.61 1,255 83.67 Case type Low rate 92 2.37 72 4.80 Normal rate 3,711 95.52 1,374 91.60 High rate 82 2.11 54 3.60 3.2 Changes in Inpatient Expenditures Before and After DRG Implementation Table 3 shows that after DRG implementation, the median total inpatient costs of the treatment group decreased from 35,857.30 yuan to 28514.58 yuan (a decrease of 20.48%), whereas the decrease in the control group was only 4.41%. Furthermore, compared with the control group, the treatment group exhibited larger decreases in medical technology costs (8.90%), drug costs (19.13%), and material costs (29.49%) than the control group, with a lesser increase in medical service costs. In terms of the inpatient costs structure, the proportion of medical service costs in the treatment group rose from 19% to 22% (a 15.79% rise), while that in the control group increased from 20% to 22% (a 10% increase). Compared to the control group, the treatment group presented a higher proportion of medical technology costs and a lower proportion of material costs. Table 3 Comparison of Patients’ Medical Expenses Before and After DRG payment method reform Variables Treatment group Control group Before(n = 633) After(n = 3252) Before(n = 283) After(n = 1217) Total_cost(RMB) 35,857.30 28514.58 27,557.24 26341.26 Medicine_cost(RMB) 5,987.20 6069.077 5,298.20 5573.465 Technical_cost(RMB) 3,820.00 3480.032 3,314.00 3139.609 Drug_cost(RMB) 7,152.12 5783.963 6,342.82 5811.874 Material_cost(RMB) 14,669.70 10344.29 9,714.63 9377.423 Medicost_ratio 0.19 ± 0.06 0.22 ± 0.06 0.20 ± 0.07 0.22 ± 0.06 Technicost_ratio 0.14 ± 0.10 0.15 ± 0.09 0.15 ± 0.10 0.14 ± 0.09 Drugcost_ratio 0.22 ± 0.09 0.22 ± 0.09 0.24 ± 0.10 0.24 ± 0.10 Matericost_ratio 0.43 ± 0.19 0.39 ± 0.15 0.40 ± 0.19 0.37 ± 0.16 3.3 Benchmark Regression Analysis 3.3.1 Effects on Inpatient Costs Level Table 4 shows that the DRG payment significantly reduced total inpatient costs for hip fracture patients by 0.043 percentage points. Drug costs were significantly reduced by 0.102 percentage points, demonstrating that the DRG payment has been highly effective in standardizing clinical medication practices and alleviating the burden of drug costs. The effects on medical service costs (such as diagnosis and treatment costs, surgical costs) and material costs were insignificant. 3.3.2 Effects on Inpatient Costs Structure Table 5 shows that DRG payment reform led to significant changes in the inpatient costs structure for hip fracture patients: the proportions of medical service costs and medical technology costs increased significantly by 0.006 and 0.011 percentage points, while the proportion of drug costs decreased significantly by 0.011 percentage points. Table 4 Effects of DRG on the amount of inpatient expenditure VARIABLES (1) (2) (3) (4) (5) In_total_cost ln_medical_cost ln_technical_cost ln_drug_cost ln_material_cost treat*time -0.043*** -0.017 0.039** -0.102*** -0.031 (0.012) (0.010) (0.019) (0.020) (0.022) gender -0.046*** -0.019** -0.050*** -0.053*** -0.053*** (0.009) (0.009) (0.014) (0.016) (0.017) age 0.003*** 0.002*** 0.005*** 0.005*** 0.005*** (0.000) (0.000) (0.000) (0.001) (0.001) operation 0.638*** 0.926*** 0.302* 0.744*** 1.675*** (0.112) (0.130) (0.177) (0.170) (0.290) clinical_outcome 0.004 0.061 0.029 0.046 0.051 (0.049) (0.057) (0.103) (0.119) (0.103) admission_route 0.002 -0.002 -0.056*** 0.104*** -0.004 (0.013) (0.013) (0.018) (0.023) (0.023) case_type 0.950*** 0.805*** 0.798*** 1.160*** 1.270*** (0.029) (0.035) (0.053) (0.057) (0.055) _cons 7.560*** 6.019*** 5.927*** 5.241*** 4.669*** (0.120) (0.143) (0.229) (0.252) (0.319) Controls YES YES YES YES YES Code FE YES YES YES YES YES Time FE YES YES YES YES YES Note: The values in parentheses represent robust standard errors, ***p < 0.001, **p < 0.05, *p < 0.1 Table 5 Effects of DRG on inpatient cost structure VARIABLES (6) (7) (8) (9) medicost_ratio technicost_ratio drugcost_ratio matericost_ratio treat*time 0.006*** 0.011*** -0.011*** -0.001 (0.002) (0.002) (0.003) (0.004) gender 0.007*** -0.001 -0.002 -0.004 (0.002) (0.002) (0.002) (0.003) age -0.000*** 0.000** 0.000 0.000 (0.000) (0.000) (0.000) (0.000) operation 0.046*** -0.134*** -0.003 0.104*** (0.014) (0.029) (0.038) (0.035) clinical_outcome 0.011 -0.003 -0.015 0.001 (0.009) (0.016) (0.015) (0.012) admission_route -0.004* -0.012*** 0.019*** -0.003 (0.002) (0.003) (0.003) (0.004) case_type -0.043*** -0.044*** 0.037*** 0.058*** (0.005) (0.007) (0.008) (0.009) _cons 0.272*** 0.359*** 0.152*** 0.162*** (0.018) (0.035) (0.041) (0.040) Controls YES YES YES YES Code FE YES YES YES YES Time FE YES YES YES YES Note: The values in parentheses represent robust standard errors, ***p < 0.001, **p < 0.05, *p < 0.1 3.4 Robust Test 3.4.1 Parallel Trends Test This study used an ex-ante evaluation to validate the parallel trends assumption, analyzing quarterly data from four periods prior to the implementation of the DRG payment reform. The test results are shown in Fig. 1 . The horizontal axis depicts the quarterly difference since the DRG payment reform, while the vertical axis reflects the regression coefficients of dummy variables at each time point and their 95% confidence intervals. The test results indicate that before the DRG implementation, the regression coefficients of core indicators (total inpatient expenditures, medical technology costs, drug costs, and the proportions of medical service costs, medical technology costs, and drug costs) were all insignificant. This demonstrates that no statistically significant differences existed in the time-varying trends of these indicators between the treatment and control groups prior to policy intervention, satisfying the parallel trend assumption and providing robust support for the validity of the baseline regression results. 3.4.2 Placebo Test Placebo tests were sequentially performed for total inpatient costs, medical technology costs, drug costs, the proportion of medical service costs, the proportion of medical technology costs, and the proportion of drug costs. The foregoing procedure was repeated 500 times, and the simulated estimated coefficients and corresponding p-values of each indicator were obtained, from which kernel density distribution plots and p-value distribution plots were drawn (Fig. 2 ). The results show that after 500 random samplings, the simulated estimated coefficients of each indicator roughly followed a normal distribution with a mean close to 0, whereas the significant actual estimated coefficients in the baseline regression (indicated by vertical dashed lines) were clearly outliers, consistent with the expectations of the placebo test. This confirms the robustness of the baseline regression results. 3.5 Heterogeneity Analysis Given that DRG payment may exert varying effects across patient characteristics and treatment approaches, this study investigated the heterogeneous effects of DRG payment reform on inpatient expenditures for hip fracture patients by gender, age group, admission route, treatment method, case type, and disease severity category. The results of the heterogeneity analysis are presented in Table 6 . The DRG payment exhibited a more pronounced cost-saving effect on males, younger patients, patients without complications or comorbidities, and patients with normal-ratio cases. Meanwhile, compared to emergency admissions and non-surgical patients, outpatients admitted or treated surgically showed statistically significant decreases in key metrics, including total inpatient expenditures following the DRG payment. The heterogeneity analysis of the DRG payment’s effects on various components of inpatient expenditures revealed that material costs for outpatients admitted, patients without complications, and non-older adult patients decreased significantly after DRG implementation, whereas material costs for emergency patients, patients with complications or comorbidities, and older adult patients did not change significantly. The current DRG payment reform encourages hospitals to eliminate wastes (including consumable waste, misuse of high-priced consumables, and overconfiguration of auxiliary consumables) by leveraging the high elasticity of material consumption in such groups. Researchers have paid close attention to high-ratio cases in the DRG payment system, which occur when total inpatient expenditures for enrolled cases exceed the DRG payment standard by a predetermined multiple (with the threshold set at three times the payment standard for tertiary hospital patients). The classification of high-ratio cases is often associated with high treatment difficulties and significant resource consumption, resulting in a narrow window for cost control. Conversely, low-ratio cases have total inpatient expenditures that are 0.4 times or lower than the average cost of the relevant grouping [ ] . For low-ratio cases, DRG implementation had no significant effect on total inpatient spending or drug costs, while medical technology costs climbed markedly. This is probably attributed to their costs already being below the DRG payment criterion, resulting in insufficient policy incentives. For high-ratio cases, material costs decreased significantly after DRG, indicating that the rigidity of total costs due to the complexity of their conditions is strong. But material costs, as the only controllable cost with optimization space, can serve as the focal point of subsequent cost-control refinement efforts. Table 6 Heterogeneity Analysis of DRG on inpatient costs VARIABLES (1) (2) (3) (4) (5) In_total_cost ln_medical_cost ln_technical_cost ln_drug_cost ln_material_cost Male treat*time -0.061*** -0.025 0.035 -0.141*** -0.046 (0.019) (0.018) (0.031) (0.035) (0.035) R-Squared 0.743 0.774 0.404 0.538 0.777 Female treat*time -0.027* -0.010 0.045** -0.067*** -0.020 (0.015) (0.012) (0.022) (0.024) (0.027) R-Squared 0.735 0.762 0.359 0.484 0.777 Non-older adults treat*time -0.089*** -0.054*** 0.019 -0.194*** -0.071* (0.020) 0.018 (0.028) (0.035) (0.038) R-Squared 0.749 0.797 0.393 0.601 0.774 Older adults treat*time -0.046** -0.028* 0.046 -0.093*** -0.034 (0.019) (0.015) (0.032) (0.031) (0.035) R-Squared 0.719 0.781 0.321 0.473 0.764 Oldest treat*time 0.003 0.013 0.051 -0.011 0.003 (0.019) (0.016) (0.032) (0.033) (0.034) R-Squared 0.746 0.785 0.350 0.483 0.806 Outpatient treat*time -0.094*** -0.046 0.005 -0.202*** -0.150*** (0.027) (0.028) (0.033) (0.054) (0.052) R-Squared 0.814 0.831 0.407 0.630 0.855 Emergency treat*time -0.037*** -0.014 0.043** -0.082*** -0.010 (0.013) (0.011) (0.020) (0.021) (0.023) R-Squared 0.718 0.747 0.377 0.466 0.754 Non-surgical treat*time 0.080 -0.004 0.525* -0.186 0.108 (0.121) (0.131) (0.302) (0.275) (0.226) R-Squared 0.627 0.617 0.356 0.558 0.526 Surgical treat*time -0.050*** -0.020** 0.018 -0.101*** -0.040** (0.011) (0.009) (0.015) (0.017) (0.020) R-Squared 0.611 0.555 0.362 0.343 0.561 Low rate disease treat*time 0.077 0.152 0.526* -0.371 0.140 (0.110) (0.125) (0.285) (0.256) (0.214) Observations 163 163 163 163 163 R-Squared 0.765 0.863 0.381 0.592 0.824 Normal rate disease treat*time -0.048*** -0.023** 0.012 -0.094*** -0.035* (0.011) (0.009) (0.015) (0.018) (0.020) Observations 5,077 5,077 5,077 5,077 5,077 R-Squared 0.626 0.647 0.273 0.305 0.700 High rate disease treat*time -0.067 -0.003 0.139 -0.005 -0.480*** (0.075) (0.096) (0.147) (0.167) (0.176) R-Squared 0.564 0.537 0.601 0.580 0.539 No complications treat*time -0.106*** -0.033* 0.017 -0.197*** -0.078** (0.021) (0.018) (0.037) (0.034) (0.039) R-Squared 0.776 0.805 0.375 0.565 0.792 Complications treat*time -0.023 -0.013 0.037* -0.068*** -0.023 (0.014) (0.012) (0.020) (0.025) (0.025) R-Squared 0.698 0.740 0.323 0.450 0.761 Controls YES YES YES YES YES Code FE YES YES YES YES YES Time FE YES YES YES YES YES Note: The values in parentheses represent robust standard errors, ***p < 0.001, **p < 0.05, *p < 0.1 4 Discussion The cost-control effects of the DRG payment on inpatient costs have initially emerged. Controlling the irrational growth of medical expenditures and optimizing the utilization of the medical insurance fund are critical to the success of DRG payment reform. Our analyses reveal that the DRG payment reform significantly reduced the total inpatient costs of hip fracture patients by 4.3%. This is consistent with previous studies Zhu et al. (2025) [ ] and Schuetz et al. (2021) [ ] , confirming that the DRG payment has encouraged hospitals to reduce unnecessary medical treatment and control costs. The DRG payment reform optimized the inpatient costs structure. This study demonstrates that the cost-control effect on drug costs was the largest, with a 1.1% decrease in drug spending. This can be explained by the fact that in the DRG payment reform process, greater emphasis is placed on the importance of clinical pathways in guiding rational drug use. Another potential reason is that supporting policies such as Volume-Based Procurement (VBP) of drugs and National Essential Medicines List (NEML) have compressed the price margin of hip fracture drugs, transforming drugs from a profit item of hospitals into a cost item and reducing the use of drugs in hospitals [ ] . The proportion of medical service costs in inpatient costs increased dramatically after the DRG implementation. Medical costs reflect the inputs of health professionals’ expertise and labor. The increased medical costs probably suggest that DRG payment reform encouraged the shifts from drug-oriented treatment to expertise-oriented treatment in hospitals. This shift could probably further improve the quality of health professionals’ diagnoses and treatments, boost their job satisfaction, and enhance workforce stability. In addition, DRG led to a marked rise in both medical technical costs and their proportion of inpatient costs among hip fracture patients, which warrants vigilance against clinicians’ abnormal practices such as cost-shifting and service unbundling after DRG payment reform. Hospitals may exploit the policy flexibility of key examination, by increasing the frequency of examinations or upgrading examination types, to offset revenue losses from other cost reductions, or excessively rely on medical examinations to avoid diagnostic and treatment risks. Based on heterogeneous analysis of patient characteristics and case types, material costs of patients admitted as outpatients, treated surgically, or without complications, reduced significantly after DRG implementation. Compared to other patients, their clinical routes are more standardized, allowing hospitals to proactively control costs and minimize resource waste. Our heterogeneity analysis results further show that DRG payment reform has primarily reduced the total inpatient costs for males, non-older adult patients, patients without complications or comorbidities, outpatients admitted or treated surgically patients, and patients with normal ratios of cases who have mature clinical pathways, highly standardized circumstances, and high cost elasticity. The DRG payment standard closely matches real clinical expenses of these patients, resulting in significant savings on overall inpatient expenditures, drug costs, and material costs. Among them, surgical patients and those with normal ratios account for 96.13% and 91.60% of the total sample, respectively. After DRG, total inpatient costs for surgical patients declined by 5.0%, while those for patients with normal ratio cases reduced by 4.8%. This reflects the DRG payment reform’s precise regulatory capacity in these cases, which currently addresses the basic diagnosis and treatment needs of the majority of patients. Nonetheless, several policy incentive blind spots remain in the present DRG payment reform, including for female patients, the older adults, and those with low or high rate cases. This is consistent with varied conclusions in studies on other high-burden diseases such as pulmonary tuberculosis and cervical cancer [ ] . Female patients are more likely to develop osteoporosis and experience fractures due to differences in bone structure and physiological factors. According to surveys, the annual incidence of hip fracture over age increases by 85% in males and 306% in females [ ] . Furthermore, older adult patients often have more comorbidities, higher surgical risks, longer post-operative recovery periods, and more complex rehabilitation requirements. The cost-control effect of DRG for such groups needs to be improved, suggesting that policy precision should be enhanced in subsequent policy implementation. For instance, optimizing reform coverage by adding “gender adjustment factors” and “age-related complication weights” to the grouping criteria. The cost-control benefit for patients with low-rate cases is insignificant, possibly because their costs are already below the DRG payment threshold, providing hospitals with insufficient incentives to control expenses. Instead, hospitals may engage in behaviors including boosting compliant medical technology services in order to raise expenses close to the designed payment level and generate additional surpluses. Enrollment in high-rate cases is frequently accompanied by high treatment difficulty and large medical resource consumption, leading to limited cost-control space [ ] . This further indicates that while the existing DRG payment policy can effectively adapt to conventional cases, it still requires improvement to handle complex cases and those with more severe diseases. 5 Strengths and limitations The strengths of this study mainly lie in its focus on a high-burden disease, refined analysis of structural differences, and identification of reliable causal effects under a DID model design. This study targets hip fractures, a representative high-burden disease. Unlike other studies on the same topic at the regional and hospital levels, this study uses patient-level data, ensuring disease-specific policy implications. Moreover, this study analyzed the cost structure, enhancing our understanding on DRG payment effects. Finally, the DID model adopted provides a reliable method for accurately identifying the causal relationship between DRG payment and inpatient expenditure control. The statistical method is particularly suitable for the causal study between policy implementation and effect, addressing endogeneity issues and enhancing the reliability of the study results. This study also has certain limitations. Relying on data from a single hospital inherently limits the generalizability of the conclusions, necessitating more extensive evidence for comparison and supplementation. Meanwhile, owing to limited access to existing data and constraints in hospital discharge summaries, we could not fully eliminate the influence of external patient factors in the control group design. Despite satisfying the parallel trend assumption, inherent sample selection bias may still exist. In addition, the formal implementation of DRG payment reform in China and the hospital included in this study is still in its initial stage. Therefore, this study only uses the data for three years after the implementation of DRG payment reform, precluding the identification of long-term policy effects. We encourage future studies provide more evidence on its long-term effects. 6 Conclusions Based on data from a tertiary hospital in Zhejiang Province, China (2019–2023), this study finds that DRG payment reform significantly contained inpatient costs for hip fracture patients and optimized the cost structure by reducing drug expenditures while increasing the proportion of medical service costs. However, challenges remain: control over technical service costs (e.g., examinations) was insufficient, with evidence suggesting possible overuse; and the policy effects were heterogeneous, mainly affecting male, non‑older adult, and surgical patients, while complex cases and cost‑outlier groups saw limited improvement. To enhance the reform, we recommend refining cost‑structure management and clinical pathways for complex patients; improving DRG grouping standards with dynamic adjustment mechanisms, especially for female and older adult subgroups; and strengthening long‑term data support and whole‑process monitoring to balance cost control with quality of care. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Wuhan University (Approval No. WHU-HSS-IRB2025089). As this study was a retrospective analysis using an anonymized dataset, the requirement for informed consent was waived by the Ethics Committee of Wuhan University. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from the hospital but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the author (contact Meili Zhang) upon reasonable request and with permission of hospital. Competing interests The authors declare no competing interests. Funding This research was supported by the National Natural Science Foundation of China (Grant ID. 71874128, Grant ID. 72574169) and Henan Zhongyuan Medical Science and Technology Innovation and Development Foundation (Grant ID. 25YCG2001). Authors’ contributions XM was responsible for study design and supervision, manuscript revision, and the provision of research funding. WHD, WMO, LX and ZY conducted data analysis and manuscript drafting. YQ offered guidance on data analysis methods. ZML was responsible for data collection and manuscript review. GBQ revised the manuscript. All authors have read and approved the final version of the manuscript. Acknowledgements Not applicable. References Pang RZ, Li QN. Kan Bing Gui and fiscal expenditure on the healthy China initiative: Based on structural imbalances in the allocation of medical and health resources. Journal of Xi'an Jiaotong University (Social Sciences) . 2024; 44(2):104–116. Li Y, Chai PP, Feng J, et al. Results and Analysis of National Health Accounts in 2023 in China. Chinese Health Economics. 2025; 44(2):1-6. Meer J, Rosen HS. Insurance and the utilization of medical services. Soc Sci Med. 2004; 58(9):1623-1632. Hussey P, Anderson GF. A comparison of single- and multi-payer health insurance systems and options for reform. Health Policy. 2003; 66(3):215-228. Wang A, Chen C, Wang M, et al. Medical Expenses for Hospitalized Patients with Cervical Cancer Before and After the Implementation of the DRG Payment Policy. Medical Journal of Peking Union Medical College Hospital. 2024; 15(5):1077-1082. Vuagnat A, Yilmaz E, Roussot A, et al. Did case-based payment influence surgical readmission rates in France? A retrospective study. BMJ Open. 2018; 8(2):e018164. Wang Y, Chen Y, Wang J, et al. The impacts of medical insurance payment methods on medical bills and medical service quality: Evidence from Xiangtan, China. Journal of Business Research. 2023; 169: 114292. Kutz A, Gut L, Ebrahimi F, et al. Association of the Swiss Diagnosis-Related Group Reimbursement System With Length of Stay, Mortality, and Readmission Rates in Hospitalized Adult Patients. JAMA network open. 2019; 2(2): e188332. Hu W Y, Yeh C F, Shiao A S, et al. Effects of diagnosis-related group payment on health-care provider behaviors: A consecutive three-period study. Journal of the Chinese Medical Association. 2015; 78(11): 678-685. Wu Y, Fung H, Shum H M, et al. Evaluation of Length of Stay, Care Volume, In-Hospital Mortality, and Emergency Readmission Rate Associated With Use of Diagnosis-Related Groups for Internal Resource Allocation in Public Hospitals in Hong Kong. JAMA Network Open. 2022; 5(2): e2145685. Busse R, Geissler A, Aaviksoo A, et al. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals. BMJ (Clinical research ed.). 2013; 346: f3197. Feder J, Hadley J, Zuckerman S. How Did Medicare’s Prospective Payment System Affect Hospitals. New England Journal of Medicine. 1987; 317(14): 867-873. Kerr G, Dunt D, Gordon I. Effect of casemix funding on outcomes in patients admitted to hospital with suspected unstable angina. Medical Journal of Australia. 1998; 168(2): 57-60. Hu XY, Lu JJ, Cui YC. Impact of DRG payment on medical resource utilisation and quality of care for hospitalized lung cancer. Medical Journal of Peking Union Medical College Hospital. 2024; 15:1059–1068. Jian W, Lu M, Chan K Y, et al. Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission. Health Affairs (Project Hope). 2015; 34(10): 1745-1752. Meng Z, Zou K, Song S, et al. Associations of Chinese diagnosis-related group systems with inpatient expenditures for older people with hip fracture. BMC Geriatrics. 2022; 22(1): 169. Damrongplasit K, Atalay K. Payment mechanism and hospital admission: New evidence from Thailand healthcare reform. Social science & medicine. 2021; 291. Kim S J, Han K, Kim W, et al. Early Impact on Outpatients of Mandatory Adoption of the Diagnosis‐Related Group‐Based Reimbursement System in Korea on Use of Outpatient Care: Differences in Medical Utilization and Presurgery Examination. Health Services Research. 2018; 53(4): 2064-2083. Wang F. Effects of remifentanil combined with dexmedetomidine on cerebral oxygen metabolism and cognitive function in patients undergoing hip arthroplasty under general anesthesia. Journal of Medical Forum. 2023; 44(7):85-87. Zhang RP, Yin YC, Li SL, et al. Interpretation of Hip Fracture Guidelines and Analysis of Current Diagnosis and Treatment Practices. Journal of Hebei Medical University. 2018; 39(6): 621-627. Ren Y, Hu J, Lu B, et al. Prevalence and risk factors of hip fracture in a middle-aged and older Chinese population. Bone. 2019; 122: 143-149. Cooper C, Campion G, Melton LJ III. Hip fractures in the elderly: a world-wide projection. Osteoporos International. 1992;2 (6):285-289. Alexiou KI, Roushias A, Varitimidis SE, et al. Quality of life and psychologicalconsequences in elderly patients after a hip fracture: a review. Clinical Interventions in Aging. 2018; 13:143-150. Riggs BL, Melton LJ. The worldwide problem of osteoporosis: insights affordedby epidemiology. Bone. 1995; 17(5 Suppl):505S-511S. Schroeder HS, Israeli A, Liebergall MI, et al. The Suitability of MeasuringPatient-Reported Outcomes in Older Adults Following a Hip Fracture Using theShort-Form 36 Questionnaire: A Qualitative Description Approach. Inquiry. 2023; 60:469580231171819. Johnell O. The socioeconomic burden of fractures: today and in the 21st century. The American journal of medicine. 1997; 103(2A):20S-25S. Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden ofosteoporosis-related fractures in the United States, 2005-2025. Journal of bone and mineral research. 2007; 22(3):465-475. Wang HY, Zhou D, Wang AY, et al. A Multi-Dimensional Coupling Study on the High-Quality Development of Public Hospitals under the Background of DRG. Chinese Hospital Management. 2025; 45(1):1-5. Wang AM, Chen CJ, Wang MJ, et al. Medical Expenses for Hospitalized Patients with Cervical Cancer Before and After the Implementation of the DRG Payment Policy. Medical Journal of Peking Union Medical College. 2024; 15(5):1077-1082. Hu RD, Lin MY. Research trends of the difference-in-differences method and its application in public policy evaluation. Finance and Economics Think Tank. 2018; 3(3):84-111, 143-144. Roth, J., Sant'Anna, P. H. C., Bilinski, A.,et al. What's trending in difference-in-differences? A synthesis of the recent econometrics literature. Journal of Econometrics. 2023; 235(2): 2218-2244. Chay K, Greenstone, M. The impact of air pollution on infant mortality: Evidence from geographic variation in pollution shocks induced by a recession. The Quarterly Journal of Economics. 2003; 118(3): 1121-1167. Wang WJ, Jia XQ, Zhou DP, et al. Grey correlation analysis of the difference between DRG high rate and normal rate cases and hospitalization cost. Chinese Hospitals. 2023; 27(5):55-58. Zhu XJ, Yu M. The Double-edged Sword Impacts of DRG/DIP Payment Reform:A Multi-Time-Point DID Empirical Assessment. Insurance Studies. 2025; (9):66-81. Schuetz P , Albrich W C , Suter I ,et al.Quality of care delivered by fee-for-service and DRG hospitals in Switzerland in patients with community-acquired pneumonia.Swiss Medical Weekly. 2011; 141(2):w13228. Huang JW. Discussion on Rational Drug Use Management Mode in Hospital Under the Background of DRG Payment. Chinese Health Standard Management. 2025; 16(10):148-151. Du HZ, Jiao WP. Study on the impact of DRG payment on the cost structure and medical treatment of patients with cerebral infarction. Soft Science of Health. 2024, 38(9):65-68, 78. Brauer CA, Coca-Perraillon M, Cutler DM, et al.Incidence and mortality of hip fractures in the united states. JAMA. 2009; 302(14):1573-79. Tang LL, Yuan SY, Feng JY, et al. Research status and prospect of life cycle management of elderly hip fracture in digital health era. Nursing Research. 2025; 39(5):852-855. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 14 May, 2026 Reviews received at journal 07 May, 2026 Reviewers agreed at journal 27 Apr, 2026 Reviewers agreed at journal 26 Apr, 2026 Reviewers agreed at journal 25 Apr, 2026 Reviews received at journal 24 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers invited by journal 15 Apr, 2026 Editor assigned by journal 13 Apr, 2026 Editor invited by journal 25 Mar, 2026 Submission checks completed at journal 25 Mar, 2026 First submitted to journal 25 Mar, 2026 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-9113175","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626154547,"identity":"47813a1c-0881-4a6b-a266-28ee9506cfc9","order_by":0,"name":"Mian Xia","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Mian","middleName":"","lastName":"Xia","suffix":""},{"id":626154550,"identity":"eca89d68-dc00-4e26-939d-0c0db7f7dd33","order_by":1,"name":"Handan Wang","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Handan","middleName":"","lastName":"Wang","suffix":""},{"id":626154553,"identity":"3f80fef4-68bc-406d-b9f1-dcaabcd1efbc","order_by":2,"name":"Mingou Wang","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Mingou","middleName":"","lastName":"Wang","suffix":""},{"id":626154557,"identity":"6e7f8904-f17a-4fcc-bb56-bf371a203024","order_by":3,"name":"Xuan Luo","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Xuan","middleName":"","lastName":"Luo","suffix":""},{"id":626154558,"identity":"03db5b13-1c83-4a86-ae34-604487d24350","order_by":4,"name":"Ying Zhang","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Zhang","suffix":""},{"id":626154559,"identity":"241a5bb1-be46-4620-8a3d-9f10735e4efd","order_by":5,"name":"Qiang Yao","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Qiang","middleName":"","lastName":"Yao","suffix":""},{"id":626154561,"identity":"014cf11b-9af1-4365-840f-3943ac3beb3c","order_by":6,"name":"Haomiao Li","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Haomiao","middleName":"","lastName":"Li","suffix":""},{"id":626154563,"identity":"1bd49d49-1058-4375-bf3d-9282c10518c6","order_by":7,"name":"Bingqing Guo","email":"","orcid":"","institution":"University of Manchester","correspondingAuthor":false,"prefix":"","firstName":"Bingqing","middleName":"","lastName":"Guo","suffix":""},{"id":626154564,"identity":"058d754d-358e-42ba-9132-d1c2cbc01b33","order_by":8,"name":"Meili Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBAC9nYwdUCGgYH5AEToAAEtPIchyngYGNgSSNbCY0CkFmbmYxIf99zhMTje803qZhuDHN+NBMbPBXi1sKVJznj2jMfgzNlt0rltDMaSNxKYpWfg0WLPzGN2m+fAYR6DG7nbbgO1JG64kcDGzIPXFqCWPyAt9988A2mpJ04LA9gWHjaQlgQDwlrY0n/2HHjGI3kmzfx3zjkJw5lnHjZL49XC3nzY4MeBO3J8xw8/Ns4ps5HnO5588DM+LehAAogZG0jQMApGwSgYBaMAGwAAwRZNXcYVGqUAAAAASUVORK5CYII=","orcid":"","institution":"Wenzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Meili","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-03-13 09:53:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9113175/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9113175/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107707032,"identity":"3180d7c8-82f8-4b79-81f0-409a7ce5602d","added_by":"auto","created_at":"2026-04-24 09:19:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":121584,"visible":true,"origin":"","legend":"\u003cp\u003eParallel Trends Test. Total inpatient expenditures (A), medical technology costs (B), drug costs (C), the proportions of medical service costs (D), the proportions of medical technology costs (E), the proportions of drug costs (F).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9113175/v1/bfe324c14eb8f295fec018b7.png"},{"id":107617819,"identity":"c355b3f8-42b2-4d53-8503-330a528eaf26","added_by":"auto","created_at":"2026-04-23 09:22:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":280597,"visible":true,"origin":"","legend":"\u003cp\u003ePlacebo Test. Total inpatient expenditures (A), medical technology costs (B), drug costs (C), the proportions of medical service costs (D), the proportions of medical technology costs (E),\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9113175/v1/9f205cf07c9195b554b284f3.png"},{"id":107709074,"identity":"c233de2d-5a1f-4d9a-a2b1-4cd665191c71","added_by":"auto","created_at":"2026-04-24 09:34:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1088872,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9113175/v1/f97bb2b1-3f59-488c-b2bb-d88bff2405a6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effects of DRG Payment on Inpatient Costs for Hip Fracture Patients: Evidence from a Tertiary Hospital in China","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eHealth expenditures have skyrocketed due to the aging population, increasingly complex illness patterns, rising medical demand, and structural imbalances in medical resources, which creates a major global challenge\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. In 2024, China\u0026rsquo;s current health expenditures reached almost 9.09 trillion yuan (nearly US\u003cspan\u003e$\u003c/span\u003e1.30 trillion), accounting for 6.7% of GDP\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. The excessively rapid growth in health expenses has placed a severe economic burden on individuals and governments, threatening the sustainability of China\u0026rsquo;s social health insurance funds. Therefore, how to control the health expenditures and enhance the efficiency of medical insurance fund utilization while ensuring medical quality has emerged as an urgent priority. Globally, various payment reforms have been explored to optimize medical resource allocation, control medical costs, and enhance service quality. By adjusting incentive mechanisms, these reforms aim to standardize clinical practices, improve the efficiency of insurance fund utilization, and restrain the irrational growth of medical expenditures\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn3\" id=\"#FNLinkFn3\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. The transition from retrospective fee-for-service (FFS) payment to prospective Diagnosis-Related Groups (DRG) payment has become a prevailing trend in medical insurance reform\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn4\" id=\"#FNLinkFn4\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. The DRG payment classifies patients into similar case groups based on diagnosis, treatment approaches and clinical procedures, calculates the average cost for each group, and establishes corresponding payment standards\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn5\" id=\"#FNLinkFn5\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Its core objective is to encourage hospitals to optimize resource allocation while promoting the quality and efficiency of medical service delivery.\u003c/p\u003e \u003cp\u003eExisting studies have demonstrated that DRG payment can yield expected outcomes such as reduction in medical expenditures and adjustments in service quality and efficiency. However, research conclusions remain inconsistent across different countries, regions, hospital types and levels\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn6\" id=\"#FNLinkFn6\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn7\" id=\"#FNLinkFn7\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, disease categories\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn8\" id=\"#FNLinkFn8\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, expense types\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn9\" id=\"#FNLinkFn9\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, and initial payment systems\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn10\" id=\"#FNLinkFn10\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn11\" id=\"#FNLinkFn11\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Studies on DRG payment\u0026rsquo;s effects on medical expenditures employ a wide range of study designs, including single-center or multi-center, national or regional, and multi-disease or specialized disease analyses. The cost-control effect of the DRG system has been supported by empirical analyses, attributed to its transparency and fixed-rate characteristics\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn12\" id=\"#FNLinkFn12\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn13\" id=\"#FNLinkFn13\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. As a major component of medical expenditures\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn14\" id=\"#FNLinkFn14\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, inpatient costs have garnered significant attention in DRG-related research. For instance, a study conducted in Beijing found that the transition from FFS to DRG reduced inpatient costs and patients\u0026rsquo; out-of-pocket payment ratios by 6.2% and 10%, respectively\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn15\" id=\"#FNLinkFn15\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Evidence from Xiangtan, a city in China, indicated that DRG payment significantly lowered various inpatient costs, including medical costs and drug costs\u003csup\u003e[7]\u003c/sup\u003e. Conversely, an empirical study from Fujian Province reported no substantial decrease in inpatient costs for older hip fracture patients (aged 60 and above) after DRG implementation\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn16\" id=\"#FNLinkFn16\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Similar contradictory conclusions have also been reported in South Korea\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn17\" id=\"#FNLinkFn17\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, Thailand\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn18\" id=\"#FNLinkFn18\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, and other regions, indicating that effects of DRG payment on inpatient expenditures varies by region and disease type, and a consensus on its actual effects has yet to be reached. Furthermore, the majority of existing literature focuses on total inpatient costs at institutional or regional levels, employing quantitative methods to assess changes before and after DRG payment method reform. There remains a paucity of studies on specific diseases, especially high-burden conditions, as well as rigorous analyses of cost structure. More empirical studies are, therefore, required to evaluate the cost-control effects of DRG payment reform in China.\u003c/p\u003e \u003cp\u003eAs a typical high-burden disease, hip fracture refers to fractures within 5 cm of the femoral head and distal lesser trochanter. Predominantly affecting the older adults, hip fracture is caused by factors such as falls and osteoporosis, characterized by hip pain and limited mobility\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn19\" id=\"#FNLinkFn19\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. It represents the most common and severe type of all fractures, accounting for approximately 23.79% of all fractures in Chinese older adults \u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn20\" id=\"#FNLinkFn20\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, with an annual incidence rate of 1.1% to 3.8% in China\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn21\" id=\"#FNLinkFn21\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. The global hip fracture cases are projected to increase by 300,000 per year after 2030, reaching 6.26\u0026nbsp;million by 2050\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn22\" id=\"#FNLinkFn22\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Hip fractures are clinically distinguished by high incidence, complication rates, disability rates, and mortality rates\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn23\" id=\"#FNLinkFn23\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Approximately 40% of older adult patients lose the ability to walk independently following a hip fracture, 60% require assistive devices for ambulation, and 33% fully lose self-care abilities within one year\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn24\" id=\"#FNLinkFn24\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Surgical treatment remains the most recommended procedure, as conservative treatment is associated with a 3\u0026ndash;4 times higher mortality rate compared to surgical treatment\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn25\" id=\"#FNLinkFn25\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Orthopedic surgeries for hip fractures have distinct characteristics: unlike other high-weight diseases such as lung cancer and gastric cancer, they require the implantation of high-value consumables, along with meticulous nursing care and medication to prevent infection. Previous studies reveal that hip fractures place a significant financial burden on healthcare systems and patients. The global treatment expenditures related to hip fractures among older adults were around US\u003cspan\u003e$\u003c/span\u003e34.8\u0026nbsp;billion in 1990\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn26\" id=\"#FNLinkFn26\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, and are predicted to rise to US\u003cspan\u003e$\u003c/span\u003e131\u0026nbsp;billion per year by 2050\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn27\" id=\"#FNLinkFn27\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Considering its high DRG weight, significant resource consumption, and significant cost volatility, hip fracture serves as a representative indicator for evaluating DRG\u0026rsquo;s cost-saving effects.\u003c/p\u003e \u003cp\u003eGiven the above background, this study focuses on the inpatient medical records of hip fracture patients at a tertiary hospital in China from 2019 to 2023, analyzing the changes in inpatient expenditures for hip fracture patients before and after the DRG implementation, in order to explore the regulatory effects of DRG payment reform on inpatient expenditures and its structure for high-burden diseases. Since 1 January 2020, the hospital has completely implemented DRG payment for all social medical insurance patients. The hospital selected for this study is a leading Grade-A tertiary hospital in Hangzhou, the provincial capital of Zhejiang Province, China. With abundant medical records that span patients from multiple cities across Zhejiang and neighboring provinces, it provides an ideal setting for our study.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Data Sources and Variable Definitions\u003c/h2\u003e \u003cp\u003eThis study retrieved clinical and medical insurance claims data for all patients with hip fracture admitted to a tertiary hospital in Zhejiang Province from 1 January 2019 to 31 December 2023. The following data are retrieved: (1) Demographic characteristics of patients, including gender, age, treatment methods, outcomes, admission route, and case type; (2) Medical expenditure amount, including the amount of total inpatient costs and each component. Following the approach developed by Wang \u003cem\u003eet al.\u003c/em\u003e (2025)\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn28\" id=\"#FNLinkFn28\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, expenses were specifically divided into medical service costs, technical service costs, drug costs, and material costs.\u003c/p\u003e \u003cp\u003eWe included inpatient patients who had a primary diagnosis of hip fracture and complete key information. Hip fractures in this study were mainly defined as femoral neck fractures, intertrochanteric fractures, and subtrochanteric fractures, with corresponding International Classification of Diseases (ICD-10) diagnostic codes (S72.0, S72.1, S72.2, T93.101, T93.102, T93.107). Patients with extreme values in total inpatient expenditures were excluded. Ultimately, 5,385 patients were included in the study sample.\u003c/p\u003e \u003cp\u003eMedical insurance patients subject to DRG payment were classified as the treatment group (n\u0026thinsp;=\u0026thinsp;3,885, accounting for 72.14% of the total sample), while self-paying patients who were not affected by the DRG payment reform during the same period served as the control group (n\u0026thinsp;=\u0026thinsp;1,500, accounting for 27.86% of the total sample). This hospital implemented DRG payment reform in 2020, which was designated as the policy intervention time point.\u003c/p\u003e \u003cp\u003eVariables used in the study are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDependent variables, independent variables and control variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eName\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbbreviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMeasurement Method\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eDependent Variable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal inpatient costs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etotal_cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal medical costs incurred during the patient's hospitalization\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical service costs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emedical_cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTreatment costs, diagnosis costs, surgical costs, nursing costs, anesthesia costs, and blood transfusion costs incurred\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTechnical service\u003c/p\u003e \u003cp\u003ecosts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etechnical_cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExamination costs and laboratory costs incurred\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDrug costs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003edrug_cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal drug costs incurred\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial costs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ematerial_cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal material costs incurred\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRatio of medical service costs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emedicost_ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRatio of medical service cost to total inpatient cost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRatio of technical service costs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etechnicost_ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRatio of technical service cost to total inpatient cost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRatio of drug costs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003edrugcost_ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRatio of drug cost to total inpatient cost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRatio of material\u003c/p\u003e \u003cp\u003ecosts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ematericost_ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRatio of material cost to total inpatient cost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIndependent Variable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolicy group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etreat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u0026thinsp;=\u0026thinsp;0, Policy group\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBefore DRG\u0026thinsp;=\u0026thinsp;0, After DRG\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNet policy effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDid(treat*time)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInteraction term between treat group and time\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eControl Variable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003egender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u0026thinsp;=\u0026thinsp;0, Female\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatient's age\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-surgical\u0026thinsp;=\u0026thinsp;0, Surgical\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eclinical_outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnimproved or deceased\u0026thinsp;=\u0026thinsp;0, Improved or cured\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdmission route\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eadmission_route\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOutpatient\u0026thinsp;=\u0026thinsp;0, Emergency\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecase_type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow rate\u0026thinsp;=\u0026thinsp;1, Normal rate\u0026thinsp;=\u0026thinsp;2, High rate\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Statistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous data (total inpatient costs, medical service costs, technical service costs, drug costs, and material costs) were converted to log form and reported as medians. The proportions of various costs were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Categorical data (gender, age group, operation, clinical outcome, admission route, and disease type) are expressed as frequency (percentage). A two-tailed test with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered statistically significant. Statistical analyses were conducted using Excel 2019 and Stata 15.0.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Difference-in-Differences (DID) Model\u003c/h2\u003e \u003cp\u003eThis study constructed a difference-in-differences (DID) model to assess changes in hip fracture patients\u0026rsquo; inpatient expenditures before and after DRG payment reform, while controlling for confounding variables such as time trends and disease classification. By creating an interaction term between \u0026ldquo;treatment\u0026rdquo; and \u0026ldquo;time point\u0026rdquo;, the DID model calculates the changes in medical expenditures of the treatment group and the control group before and after policy implementation, with the difference between these changes representing the net effects of the DRG reform on expenditures\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn29\" id=\"#FNLinkFn29\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. The following DID model was formulated:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:{\\text{Y}}_{\\text{i}\\text{t}}={{\\beta\\:}}_{0}+{{\\beta\\:}}_{1}{\\times\\:\\text{t}\\text{r}\\text{e}\\text{a}\\text{t}}_{\\text{i}}+{{\\beta\\:}}_{2}\\times\\:{\\text{t}\\text{i}\\text{m}\\text{e}}_{\\text{t}}+{{\\beta\\:}}_{3}\\times\\:\\left({\\text{t}\\text{r}\\text{e}\\text{a}\\text{t}}_{\\text{i}}\\times\\:{\\text{t}\\text{i}\\text{m}\\text{e}}_{\\text{t}}\\right)+\\sum\\:{\\lambda\\:}{\\text{X}}_{\\text{i}\\text{t}}+{+\\text{ϵ}}_{\\text{i}\\text{t}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWherein, the dependent variable \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{Y}}_{\\text{it}}\\)\u003c/span\u003e\u003c/span\u003e represents total inpatient costs, medical service costs, technical service costs, drug costs, material costs, and their respective proportions. Considering the skewed distribution of medical costs, the natural logarithm of each cost indicator was taken. The independent variables \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{trea}{\\text{t}}_{\\text{i}}\\)\u003c/span\u003e\u003c/span\u003e and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{tim}{\\text{e}}_{\\text{t}}\\)\u003c/span\u003e\u003c/span\u003e represented the grouping dummy variable and time dummy variable before and after the DRG policy, respectively. \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{trea}{\\text{t}}_{\\text{i}}\\text{\u0026times;}\\text{tim}{\\text{e}}_{\\text{t}}\\)\u003c/span\u003e\u003c/span\u003e is the interaction term of our interest. \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\sum\\:\\lambda\\:{X}_{it}\\)\u003c/span\u003e\u003c/span\u003e represents control variables in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e to exclude interference of non-policy factors on inpatient costs. In addition, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{ϵ}}_{\\text{it}}\\)\u003c/span\u003e\u003c/span\u003e is the random error term; \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{\u0026beta;}}_{\\text{0}}\\)\u003c/span\u003e\u003c/span\u003e is the constant term (intercept); \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{\u0026beta;}}_{\\text{1}}\\)\u003c/span\u003e\u003c/span\u003e and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{\u0026beta;}}_{\\text{2}}\\)\u003c/span\u003e\u003c/span\u003e represents the DRG effect and time fixed effect coefficients, respectively; \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\text{\u0026beta;}}_{\\text{3}}\\)\u003c/span\u003e\u003c/span\u003e represents the net effect of the DRG policy on inpatient expenditures for hip fracture patients. This model also controlled for year-fixed effects and disease-grouping-fixed effects.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Robust Test\u003c/h2\u003e \u003cp\u003eTo ensure the unbiasedness of the estimated DID coefficient, this assumption requires parallel pre-intervention trends between the treatment group and control group, with no statistically significant differences observed prior to the DRG implementation\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn30\" id=\"#FNLinkFn30\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. This study used an ex-ante evaluation technique for parallel trend testing following Roth \u003cem\u003eet al.\u003c/em\u003e (2023)\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn31\" id=\"#FNLinkFn31\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. The parallel trend test graph presents quarterly data for 2019, a pre-implementation period of the DRG payment reform. The parallel trend assumption is satisfied if the 95% confidence interval (CI) of the coefficient includes 0 for all periods; otherwise, the coefficient is statistically significant, and the test fails.\u003c/p\u003e \u003cp\u003eTo further rule out the effects of additional unobservable and random factors on the baseline regression results, this study additionally performed a placebo test to ensure their robustness. Following Chay \u0026amp; Greenstone (2003) \u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn32\" id=\"#FNLinkFn32\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, if the observed effects in benchmark regression were caused by the DRG payment reform, the policy effects simulated by randomly generating policy implementation time points should not be statistically significant.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Basic Characteristics of Hip Fracture Patients\u003c/h2\u003e \u003cp\u003eA total of 5,385 clinical cases of hip fracture patients were included in this study, with 3,885 in the treatment group and 1,500 in the control group. Their demographics and clinical characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Females accounted for 68.08% of the treatment group and 54.93% of the control group, with a higher proportion of females than males in both groups. This aligns with the higher incidence of osteoporosis in females seen in clinical practice, indicating that females are at a higher risk of hip fracture. Older adult patients aged 65 and above numbered 3,203 in the treatment group and 792 in the control group, confirming that the hip fracture incidence is significantly concentrated in the older adults. The vast majority of patients in both groups underwent surgery, consistent with the clinical principle of early surgical intervention for hip fractures to restore function and prevent bedridden complications. Overall, 98.10% and 97.93% of patients in the treatment and control groups, respectively, achieved clinical improvement following surgery or other hospital procedures. Regarding the admission route, the emergency admission rate exceeded 80% in two groups, indicating that hip fracture was frequently caused by accidental occurrences such as falls, resulting in an acute onset and severe condition requiring immediate medical attention. In terms of case type, normal cases accounted for 90% in the two groups, indicating that most hip fracture costs fall within the DRG payment threshold.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of Patients with Hip Fracture\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTreat\u0026thinsp;=\u0026thinsp;1(n\u0026thinsp;=\u0026thinsp;3,885)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTreat\u0026thinsp;=\u0026thinsp;0(n\u0026thinsp;=\u0026thinsp;1,500)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentage(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e54.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e47.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-surgical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,729\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e96.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnimproved/Deceased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproved/Cured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e97.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdmission route\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutpatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e83.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e91.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Changes in Inpatient Expenditures Before and After DRG Implementation\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that after DRG implementation, the median total inpatient costs of the treatment group decreased from 35,857.30 yuan to 28514.58 yuan (a decrease of 20.48%), whereas the decrease in the control group was only 4.41%. Furthermore, compared with the control group, the treatment group exhibited larger decreases in medical technology costs (8.90%), drug costs (19.13%), and material costs (29.49%) than the control group, with a lesser increase in medical service costs. In terms of the inpatient costs structure, the proportion of medical service costs in the treatment group rose from 19% to 22% (a 15.79% rise), while that in the control group increased from 20% to 22% (a 10% increase). Compared to the control group, the treatment group presented a higher proportion of medical technology costs and a lower proportion of material costs.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Patients\u0026rsquo; Medical Expenses Before and After DRG payment method reform\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTreatment group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore(n\u0026thinsp;=\u0026thinsp;633)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfter(n\u0026thinsp;=\u0026thinsp;3252)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBefore(n\u0026thinsp;=\u0026thinsp;283)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAfter(n\u0026thinsp;=\u0026thinsp;1217)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal_cost(RMB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35,857.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28514.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27,557.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26341.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicine_cost(RMB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,987.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6069.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,298.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5573.465\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTechnical_cost(RMB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,820.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3480.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,314.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3139.609\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug_cost(RMB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7,152.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5783.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6,342.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5811.874\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaterial_cost(RMB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14,669.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10344.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9,714.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9377.423\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicost_ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTechnicost_ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrugcost_ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMatericost_ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Benchmark Regression Analysis\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Effects on Inpatient Costs Level\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that the DRG payment significantly reduced total inpatient costs for hip fracture patients by 0.043 percentage points. Drug costs were significantly reduced by 0.102 percentage points, demonstrating that the DRG payment has been highly effective in standardizing clinical medication practices and alleviating the burden of drug costs. The effects on medical service costs (such as diagnosis and treatment costs, surgical costs) and material costs were insignificant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 Effects on Inpatient Costs Structure\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows that DRG payment reform led to significant changes in the inpatient costs structure for hip fracture patients: the proportions of medical service costs and medical technology costs increased significantly by 0.006 and 0.011 percentage points, while the proportion of drug costs decreased significantly by 0.011 percentage points.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffects of DRG on the amount of inpatient expenditure\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVARIABLES\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(5)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn_total_cost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eln_medical_cost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eln_technical_cost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eln_drug_cost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eln_material_cost\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.043***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.039**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.102***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.010)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.022)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.046***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.019**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.050***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.053***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.053***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.017)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.003***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.001)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.638***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.926***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.302*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.744***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.675***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.112)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.130)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.177)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.170)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.290)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eclinical_outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.049)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.057)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.103)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.119)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.103)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eadmission_route\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.056***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.104***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.023)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecase_type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.950***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.805***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.798***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.160***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.270***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.029)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.035)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.053)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.057)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.055)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e_cons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.560***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.019***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.927***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.241***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.669***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.143)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.229)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.252)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.319)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCode FE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime FE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: The values in parentheses represent robust standard errors, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.1\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffects of DRG on inpatient cost structure\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVARIABLES\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(9)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003emedicost_ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003etechnicost_ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003edrugcost_ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ematericost_ratio\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.006***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.011***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.011***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.004)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.007***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.003)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.000***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.000)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.046***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.134***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.104***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.029)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.038)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.035)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eclinical_outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.012)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eadmission_route\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.004*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.012***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.019***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.004)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecase_type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.043***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.044***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.037***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.058***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.007)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.009)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e_cons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.272***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.359***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.152***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.162***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.035)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.041)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.040)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCode FE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime FE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: The values in parentheses represent robust standard errors, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.1\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Robust Test\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.4.1 Parallel Trends Test\u003c/h2\u003e \u003cp\u003eThis study used an ex-ante evaluation to validate the parallel trends assumption, analyzing quarterly data from four periods prior to the implementation of the DRG payment reform. The test results are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The horizontal axis depicts the quarterly difference since the DRG payment reform, while the vertical axis reflects the regression coefficients of dummy variables at each time point and their 95% confidence intervals. The test results indicate that before the DRG implementation, the regression coefficients of core indicators (total inpatient expenditures, medical technology costs, drug costs, and the proportions of medical service costs, medical technology costs, and drug costs) were all insignificant. This demonstrates that no statistically significant differences existed in the time-varying trends of these indicators between the treatment and control groups prior to policy intervention, satisfying the parallel trend assumption and providing robust support for the validity of the baseline regression results.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.4.2 Placebo Test\u003c/h2\u003e \u003cp\u003ePlacebo tests were sequentially performed for total inpatient costs, medical technology costs, drug costs, the proportion of medical service costs, the proportion of medical technology costs, and the proportion of drug costs. The foregoing procedure was repeated 500 times, and the simulated estimated coefficients and corresponding p-values of each indicator were obtained, from which kernel density distribution plots and p-value distribution plots were drawn (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The results show that after 500 random samplings, the simulated estimated coefficients of each indicator roughly followed a normal distribution with a mean close to 0, whereas the significant actual estimated coefficients in the baseline regression (indicated by vertical dashed lines) were clearly outliers, consistent with the expectations of the placebo test. This confirms the robustness of the baseline regression results.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Heterogeneity Analysis\u003c/h2\u003e \u003cp\u003eGiven that DRG payment may exert varying effects across patient characteristics and treatment approaches, this study investigated the heterogeneous effects of DRG payment reform on inpatient expenditures for hip fracture patients by gender, age group, admission route, treatment method, case type, and disease severity category. The results of the heterogeneity analysis are presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. The DRG payment exhibited a more pronounced cost-saving effect on males, younger patients, patients without complications or comorbidities, and patients with normal-ratio cases. Meanwhile, compared to emergency admissions and non-surgical patients, outpatients admitted or treated surgically showed statistically significant decreases in key metrics, including total inpatient expenditures following the DRG payment. The heterogeneity analysis of the DRG payment\u0026rsquo;s effects on various components of inpatient expenditures revealed that material costs for outpatients admitted, patients without complications, and non-older adult patients decreased significantly after DRG implementation, whereas material costs for emergency patients, patients with complications or comorbidities, and older adult patients did not change significantly. The current DRG payment reform encourages hospitals to eliminate wastes (including consumable waste, misuse of high-priced consumables, and overconfiguration of auxiliary consumables) by leveraging the high elasticity of material consumption in such groups.\u003c/p\u003e \u003cp\u003eResearchers have paid close attention to high-ratio cases in the DRG payment system, which occur when total inpatient expenditures for enrolled cases exceed the DRG payment standard by a predetermined multiple (with the threshold set at three times the payment standard for tertiary hospital patients). The classification of high-ratio cases is often associated with high treatment difficulties and significant resource consumption, resulting in a narrow window for cost control. Conversely, low-ratio cases have total inpatient expenditures that are 0.4 times or lower than the average cost of the relevant grouping\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn33\" id=\"#FNLinkFn33\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. For low-ratio cases, DRG implementation had no significant effect on total inpatient spending or drug costs, while medical technology costs climbed markedly. This is probably attributed to their costs already being below the DRG payment criterion, resulting in insufficient policy incentives. For high-ratio cases, material costs decreased significantly after DRG, indicating that the rigidity of total costs due to the complexity of their conditions is strong. But material costs, as the only controllable cost with optimization space, can serve as the focal point of subsequent cost-control refinement efforts.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHeterogeneity Analysis of DRG on inpatient costs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVARIABLES\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(4)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(5)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn_total_cost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eln_medical_cost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eln_technical_cost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eln_drug_cost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eln_material_cost\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.061***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.141***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.031)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.035)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.035)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.027*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.045**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.067***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.027)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.735\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-older adults\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.089***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.054***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.194***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.071*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.028)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.035)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.038)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.774\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOlder adults\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.046**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.028*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.093***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.032)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.031)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.035)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.719\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOldest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.032)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.033)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.034)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.806\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutpatient\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.094***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.202***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.150***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.027)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.028)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.033)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.054)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.052)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.831\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.855\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmergency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.037***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.043**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.082***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.023)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.747\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.754\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-surgical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.525*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.121)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.131)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.302)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.275)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.226)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.050***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.020**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.101***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.040**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.020)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLow rate\u003c/b\u003e disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.526*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.110)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.125)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.285)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.256)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.214)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.824\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNormal rate\u003c/b\u003e disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.048***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.023**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.094***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.035*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.020)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.626\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHigh rate\u003c/b\u003e disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.480***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.075)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.096)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.147)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.167)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.176)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.106***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.033*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.197***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.078**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.037)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.034)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.039)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etreat*time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.037*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.068***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(0.014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(0.025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.025)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-Squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.761\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCode FE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime FE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: The values in parentheses represent robust standard errors, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.1\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThe cost-control effects of the DRG payment on inpatient costs have initially emerged. Controlling the irrational growth of medical expenditures and optimizing the utilization of the medical insurance fund are critical to the success of DRG payment reform. Our analyses reveal that the DRG payment reform significantly reduced the total inpatient costs of hip fracture patients by 4.3%. This is consistent with previous studies Zhu \u003cem\u003eet al.\u003c/em\u003e (2025) \u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn34\" id=\"#FNLinkFn34\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e and Schuetz \u003cem\u003eet al.\u003c/em\u003e (2021) \u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn35\" id=\"#FNLinkFn35\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, confirming that the DRG payment has encouraged hospitals to reduce unnecessary medical treatment and control costs.\u003c/p\u003e \u003cp\u003eThe DRG payment reform optimized the inpatient costs structure. This study demonstrates that the cost-control effect on drug costs was the largest, with a 1.1% decrease in drug spending. This can be explained by the fact that in the DRG payment reform process, greater emphasis is placed on the importance of clinical pathways in guiding rational drug use. Another potential reason is that supporting policies such as Volume-Based Procurement (VBP) of drugs and National Essential Medicines List (NEML) have compressed the price margin of hip fracture drugs, transforming drugs from a profit item of hospitals into a cost item and reducing the use of drugs in hospitals\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn36\" id=\"#FNLinkFn36\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. The proportion of medical service costs in inpatient costs increased dramatically after the DRG implementation. Medical costs reflect the inputs of health professionals\u0026rsquo; expertise and labor. The increased medical costs probably suggest that DRG payment reform encouraged the shifts from drug-oriented treatment to expertise-oriented treatment in hospitals. This shift could probably further improve the quality of health professionals\u0026rsquo; diagnoses and treatments, boost their job satisfaction, and enhance workforce stability. In addition, DRG led to a marked rise in both medical technical costs and their proportion of inpatient costs among hip fracture patients, which warrants vigilance against clinicians\u0026rsquo; abnormal practices such as cost-shifting and service unbundling after DRG payment reform. Hospitals may exploit the policy flexibility of key examination, by increasing the frequency of examinations or upgrading examination types, to offset revenue losses from other cost reductions, or excessively rely on medical examinations to avoid diagnostic and treatment risks. Based on heterogeneous analysis of patient characteristics and case types, material costs of patients admitted as outpatients, treated surgically, or without complications, reduced significantly after DRG implementation. Compared to other patients, their clinical routes are more standardized, allowing hospitals to proactively control costs and minimize resource waste.\u003c/p\u003e \u003cp\u003eOur heterogeneity analysis results further show that DRG payment reform has primarily reduced the total inpatient costs for males, non-older adult patients, patients without complications or comorbidities, outpatients admitted or treated surgically patients, and patients with normal ratios of cases who have mature clinical pathways, highly standardized circumstances, and high cost elasticity. The DRG payment standard closely matches real clinical expenses of these patients, resulting in significant savings on overall inpatient expenditures, drug costs, and material costs. Among them, surgical patients and those with normal ratios account for 96.13% and 91.60% of the total sample, respectively. After DRG, total inpatient costs for surgical patients declined by 5.0%, while those for patients with normal ratio cases reduced by 4.8%. This reflects the DRG payment reform\u0026rsquo;s precise regulatory capacity in these cases, which currently addresses the basic diagnosis and treatment needs of the majority of patients.\u003c/p\u003e \u003cp\u003eNonetheless, several policy incentive blind spots remain in the present DRG payment reform, including for female patients, the older adults, and those with low or high rate cases. This is consistent with varied conclusions in studies on other high-burden diseases such as pulmonary tuberculosis and cervical cancer\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn37\" id=\"#FNLinkFn37\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Female patients are more likely to develop osteoporosis and experience fractures due to differences in bone structure and physiological factors. According to surveys, the annual incidence of hip fracture over age increases by 85% in males and 306% in females\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn38\" id=\"#FNLinkFn38\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Furthermore, older adult patients often have more comorbidities, higher surgical risks, longer post-operative recovery periods, and more complex rehabilitation requirements. The cost-control effect of DRG for such groups needs to be improved, suggesting that policy precision should be enhanced in subsequent policy implementation. For instance, optimizing reform coverage by adding \u0026ldquo;gender adjustment factors\u0026rdquo; and \u0026ldquo;age-related complication weights\u0026rdquo; to the grouping criteria. The cost-control benefit for patients with low-rate cases is insignificant, possibly because their costs are already below the DRG payment threshold, providing hospitals with insufficient incentives to control expenses. Instead, hospitals may engage in behaviors including boosting compliant medical technology services in order to raise expenses close to the designed payment level and generate additional surpluses. Enrollment in high-rate cases is frequently accompanied by high treatment difficulty and large medical resource consumption, leading to limited cost-control space \u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn39\" id=\"#FNLinkFn39\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. This further indicates that while the existing DRG payment policy can effectively adapt to conventional cases, it still requires improvement to handle complex cases and those with more severe diseases.\u003c/p\u003e"},{"header":"5 Strengths and limitations","content":"\u003cp\u003eThe strengths of this study mainly lie in its focus on a high-burden disease, refined analysis of structural differences, and identification of reliable causal effects under a DID model design. This study targets hip fractures, a representative high-burden disease. Unlike other studies on the same topic at the regional and hospital levels, this study uses patient-level data, ensuring disease-specific policy implications. Moreover, this study analyzed the cost structure, enhancing our understanding on DRG payment effects. Finally, the DID model adopted provides a reliable method for accurately identifying the causal relationship between DRG payment and inpatient expenditure control. The statistical method is particularly suitable for the causal study between policy implementation and effect, addressing endogeneity issues and enhancing the reliability of the study results.\u003c/p\u003e \u003cp\u003eThis study also has certain limitations. Relying on data from a single hospital inherently limits the generalizability of the conclusions, necessitating more extensive evidence for comparison and supplementation. Meanwhile, owing to limited access to existing data and constraints in hospital discharge summaries, we could not fully eliminate the influence of external patient factors in the control group design. Despite satisfying the parallel trend assumption, inherent sample selection bias may still exist. In addition, the formal implementation of DRG payment reform in China and the hospital included in this study is still in its initial stage. Therefore, this study only uses the data for three years after the implementation of DRG payment reform, precluding the identification of long-term policy effects. We encourage future studies provide more evidence on its long-term effects.\u003c/p\u003e"},{"header":"6 Conclusions","content":"\u003cp\u003eBased on data from a tertiary hospital in Zhejiang Province, China (2019\u0026ndash;2023), this study finds that DRG payment reform significantly contained inpatient costs for hip fracture patients and optimized the cost structure by reducing drug expenditures while increasing the proportion of medical service costs. However, challenges remain: control over technical service costs (e.g., examinations) was insufficient, with evidence suggesting possible overuse; and the policy effects were heterogeneous, mainly affecting male, non‑older adult, and surgical patients, while complex cases and cost‑outlier groups saw limited improvement. To enhance the reform, we recommend refining cost‑structure management and clinical pathways for complex patients; improving DRG grouping standards with dynamic adjustment mechanisms, especially for female and older adult subgroups; and strengthening long‑term data support and whole‑process monitoring to balance cost control with quality of care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Wuhan University (Approval No. WHU-HSS-IRB2025089). As this study was a retrospective analysis using an anonymized dataset, the requirement for informed consent was waived by the Ethics Committee of Wuhan University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the hospital but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the author (contact Meili Zhang) upon reasonable request and with permission of hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the National Natural Science Foundation of China (Grant ID. 71874128, Grant ID. 72574169) and Henan Zhongyuan Medical Science and Technology Innovation and Development Foundation (Grant ID. 25YCG2001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXM was responsible for study design and supervision, manuscript revision, and the provision of research funding. WHD, WMO, LX and ZY conducted data analysis and manuscript drafting. YQ offered guidance on data analysis methods. ZML was responsible for data collection and manuscript review. GBQ revised the manuscript. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePang RZ, Li QN. Kan Bing Gui and fiscal expenditure on the healthy China initiative: Based on structural imbalances in the allocation of medical and health resources. Journal of Xi\u0026apos;an Jiaotong University (Social Sciences)\u003cem\u003e.\u0026nbsp;\u003c/em\u003e2024; 44(2):104\u0026ndash;116.\u003c/li\u003e\n \u003cli\u003eLi Y, Chai PP, Feng J, et al. Results and Analysis of National Health Accounts in 2023 in China. Chinese Health Economics. 2025; 44(2):1-6.\u003c/li\u003e\n \u003cli\u003eMeer J, Rosen HS. Insurance and the utilization of medical services. Soc Sci Med. 2004; 58(9):1623-1632.\u003c/li\u003e\n \u003cli\u003eHussey P, Anderson GF. A comparison of single- and multi-payer health insurance systems and options for reform. Health Policy. 2003; 66(3):215-228.\u003c/li\u003e\n \u003cli\u003eWang A, Chen C, Wang M, et al. Medical Expenses for Hospitalized Patients with Cervical Cancer Before and After the Implementation of the DRG Payment Policy. Medical Journal of Peking Union Medical College Hospital. 2024; 15(5):1077-1082.\u003c/li\u003e\n \u003cli\u003eVuagnat A, Yilmaz E, Roussot A, et al. Did case-based payment influence surgical readmission rates in France? A retrospective study. BMJ Open. 2018; 8(2):e018164.\u003c/li\u003e\n \u003cli\u003eWang Y, Chen Y, Wang J, et al. The impacts of medical insurance payment methods on medical bills and medical service quality: Evidence from Xiangtan, China. Journal of Business Research. 2023; 169: 114292.\u003c/li\u003e\n \u003cli\u003eKutz A, Gut L, Ebrahimi F, et al. Association of the Swiss Diagnosis-Related Group Reimbursement System With Length of Stay, Mortality, and Readmission Rates in Hospitalized Adult Patients. JAMA network open. 2019; 2(2): e188332.\u003c/li\u003e\n \u003cli\u003eHu W Y, Yeh C F, Shiao A S, et al. Effects of diagnosis-related group payment on health-care provider behaviors: A consecutive three-period study. Journal of the Chinese Medical Association. 2015; 78(11): 678-685.\u003c/li\u003e\n \u003cli\u003eWu Y, Fung H, Shum H M, et al. Evaluation of Length of Stay, Care Volume, In-Hospital Mortality, and Emergency Readmission Rate Associated With Use of Diagnosis-Related Groups for Internal Resource Allocation in Public Hospitals in Hong Kong. JAMA Network Open. 2022; 5(2): e2145685.\u003c/li\u003e\n \u003cli\u003eBusse R, Geissler A, Aaviksoo A, et al. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals. BMJ (Clinical research ed.). 2013; 346: f3197.\u003c/li\u003e\n \u003cli\u003eFeder J, Hadley J, Zuckerman S. How Did Medicare\u0026rsquo;s Prospective Payment System Affect Hospitals. New England Journal of Medicine. 1987; 317(14): 867-873.\u003c/li\u003e\n \u003cli\u003eKerr G, Dunt D, Gordon I. Effect of casemix funding on outcomes in patients admitted to hospital with suspected unstable angina. Medical Journal of Australia. 1998; 168(2): 57-60.\u003c/li\u003e\n \u003cli\u003eHu XY, Lu JJ, Cui YC. Impact of DRG payment on medical resource utilisation and quality of care for hospitalized lung cancer. Medical Journal of Peking Union Medical College Hospital. 2024; 15:1059\u0026ndash;1068.\u003c/li\u003e\n \u003cli\u003eJian W, Lu M, Chan K Y, et al. Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission. Health Affairs (Project Hope). 2015; 34(10): 1745-1752.\u003c/li\u003e\n \u003cli\u003eMeng Z, Zou K, Song S, et al. Associations of Chinese diagnosis-related group systems with inpatient expenditures for older people with hip fracture. BMC Geriatrics. 2022; 22(1): 169.\u003c/li\u003e\n \u003cli\u003eDamrongplasit K, Atalay K. Payment mechanism and hospital admission: New evidence from Thailand healthcare reform. Social science \u0026amp; medicine. 2021; 291.\u003c/li\u003e\n \u003cli\u003eKim S J, Han K, Kim W, et al. Early Impact on Outpatients of Mandatory Adoption of the Diagnosis‐Related Group‐Based Reimbursement System in Korea on Use of Outpatient Care: Differences in Medical Utilization and Presurgery Examination. Health Services Research. 2018; 53(4): 2064-2083.\u003c/li\u003e\n \u003cli\u003eWang F. Effects of remifentanil combined with dexmedetomidine on cerebral oxygen metabolism and cognitive function in patients undergoing hip arthroplasty under general anesthesia. Journal of Medical Forum. 2023; 44(7):85-87.\u003c/li\u003e\n \u003cli\u003eZhang RP, Yin YC, Li SL, et al. Interpretation of Hip Fracture Guidelines and Analysis of Current Diagnosis and Treatment Practices. Journal of Hebei Medical University. 2018; 39(6): 621-627.\u003c/li\u003e\n \u003cli\u003eRen Y, Hu J, Lu B, et al. Prevalence and risk factors of hip fracture in a middle-aged and older Chinese population. Bone. 2019; 122: 143-149.\u003c/li\u003e\n \u003cli\u003eCooper C, Campion G, Melton LJ III. Hip fractures in the elderly: a world-wide projection. Osteoporos International. 1992;2 (6):285-289.\u003c/li\u003e\n \u003cli\u003eAlexiou KI, Roushias A, Varitimidis SE, et al. Quality of life and psychologicalconsequences in elderly patients after a hip fracture: a review. Clinical Interventions in Aging. 2018; 13:143-150.\u003c/li\u003e\n \u003cli\u003eRiggs BL, Melton LJ. The worldwide problem of osteoporosis: insights affordedby epidemiology. Bone. 1995; 17(5 Suppl):505S-511S.\u003c/li\u003e\n \u003cli\u003eSchroeder HS, Israeli A, Liebergall MI, et al. The Suitability of MeasuringPatient-Reported Outcomes in Older Adults Following a Hip Fracture Using theShort-Form 36 Questionnaire: A Qualitative Description Approach. Inquiry. 2023; 60:469580231171819.\u003c/li\u003e\n \u003cli\u003eJohnell O. The socioeconomic burden of fractures: today and in the 21st century. The American journal of medicine. 1997; 103(2A):20S-25S.\u003c/li\u003e\n \u003cli\u003eBurge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden ofosteoporosis-related fractures in the United States, 2005-2025. Journal of bone and mineral research. 2007; 22(3):465-475.\u003c/li\u003e\n \u003cli\u003eWang HY, Zhou D, Wang AY, et al. A Multi-Dimensional Coupling Study on the High-Quality Development of Public Hospitals under the Background of DRG. Chinese Hospital Management. 2025; 45(1):1-5.\u003c/li\u003e\n \u003cli\u003eWang AM, Chen CJ, Wang MJ, et al. Medical Expenses for Hospitalized Patients with Cervical Cancer Before and After the Implementation of the DRG Payment Policy. Medical Journal of Peking Union Medical College. 2024; 15(5):1077-1082.\u003c/li\u003e\n \u003cli\u003eHu RD, Lin MY. Research trends of the difference-in-differences method and its application in public policy evaluation. Finance and Economics Think Tank. 2018; 3(3):84-111, 143-144.\u003c/li\u003e\n \u003cli\u003eRoth, J., Sant\u0026apos;Anna, P. H. C., Bilinski, A.,et al. What\u0026apos;s trending in difference-in-differences? A synthesis of the recent econometrics literature. Journal of Econometrics. 2023; 235(2): 2218-2244.\u003c/li\u003e\n \u003cli\u003eChay K, Greenstone, M. The impact of air pollution on infant mortality: Evidence from geographic variation in pollution shocks induced by a recession. The Quarterly Journal of Economics. 2003; 118(3): 1121-1167.\u003c/li\u003e\n \u003cli\u003eWang WJ, Jia XQ, Zhou DP, et al. Grey correlation analysis of the difference between DRG high rate and normal rate cases and hospitalization cost. Chinese Hospitals. 2023; 27(5):55-58.\u003c/li\u003e\n \u003cli\u003eZhu XJ, Yu M. The Double-edged Sword Impacts of DRG/DIP Payment Reform:A Multi-Time-Point DID Empirical Assessment. Insurance Studies. 2025; (9):66-81.\u003c/li\u003e\n \u003cli\u003eSchuetz P , Albrich W C , Suter I ,et al.Quality of care delivered by fee-for-service and DRG hospitals in Switzerland in patients with community-acquired pneumonia.Swiss Medical Weekly. 2011; 141(2):w13228.\u003c/li\u003e\n \u003cli\u003eHuang JW. Discussion on Rational Drug Use Management Mode in Hospital Under the Background of DRG Payment. Chinese Health Standard Management. 2025; 16(10):148-151.\u003c/li\u003e\n \u003cli\u003eDu HZ, Jiao WP. Study on the impact of DRG payment on the cost structure and medical treatment of patients with cerebral infarction. Soft Science of Health. 2024, 38(9):65-68, 78.\u003c/li\u003e\n \u003cli\u003eBrauer CA, Coca-Perraillon M, Cutler DM, et al.Incidence and mortality of hip fractures in the united states. JAMA. 2009; 302(14):1573-79.\u003c/li\u003e\n \u003cli\u003eTang LL, Yuan SY, Feng JY, et al. Research status and prospect of life cycle management of elderly hip fracture in digital health era. Nursing Research. 2025; 39(5):852-855.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"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":"Diagnosis-Related Group (DRG), inpatient costs, cost structure, hip fracture","lastPublishedDoi":"10.21203/rs.3.rs-9113175/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9113175/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDiagnosis related groups payment (DRG) is a key policy for controlling medical insurance costs in China. Hip fracture, a typical disease with high disease burden and resource consumption, serves as a key window to evaluate the effectiveness of DRG reform, but its response to the reform has not been fully verified. This study aims to clarify the effects of DRG payment reform on inpatient costs and the cost structure of hip fracture patients, providing empirical evidence for policy optimization.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eData on 5,385 hospitalized patients with hip fractures were retrospectively obtained from medical insurance claims data of a tertiary hospital in China from 2019 to 2023, using 2020 as the time point. This study employs a difference-in-differences (DID) model to assess the DRG policy\u0026rsquo;s effects on cost-control, supplemented by robustness tests and heterogeneity analyses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results show that after the DRG implementation, the total inpatient costs for hip fracture patients decreased significantly by 4.3% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), the proportion of drug costs dropped by 1.1% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the proportion of medical costs and technical costs, respectively, increased by 0.6% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 1.1% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Male, non-older adult, outpatient-admitted, surgically treated, complication-free, and normal-rate cases were the core beneficiaries, with significant reductions in total inpatient costs, drug costs, and material costs. However, the cost control effect was insufficient for female, older adult patients, and high/low-rate cases.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe DRG payment reform has preliminarily controlled the cost and optimized the expense structure for hip fracture inpatients. Given the heterogeneity of its cost-control effects, future policy implementation should take into account the characteristics of different patient groups and case types to expand the positive policy effects of DRG.\u003c/p\u003e","manuscriptTitle":"The Effects of DRG Payment on Inpatient Costs for Hip Fracture Patients: Evidence from a Tertiary Hospital in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 09:22:35","doi":"10.21203/rs.3.rs-9113175/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-14T08:29:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T02:41:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55488794419432750933556307941082976226","date":"2026-04-27T21:47:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235899385578861373126292452262959377346","date":"2026-04-26T16:24:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5062736127360004179056383432224589089","date":"2026-04-25T13:26:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-25T03:29:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209771939182226562766080617310802771377","date":"2026-04-17T04:18:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-15T08:05:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-13T08:36:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-25T09:41:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-25T05:44:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-03-25T05:39:29+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":"4d4d4cf8-0b73-4b61-a073-37e8d365561f","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-14T08:29:54+00:00","index":84,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T02:41:10+00:00","index":83,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T09:22:35+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 09:22:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9113175","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9113175","identity":"rs-9113175","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}