Analysis of the Impact of C-DRG Reform on Hospitalization Costs and Length of Stay in Patients with Lumbar Spinal Stenosis

Analysis of the Impact of C-DRG Reform on Hospitalization Costs and Length of Stay in Patients with Lumbar Spinal Stenosis | 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 Article Analysis of the Impact of C-DRG Reform on Hospitalization Costs and Length of Stay in Patients with Lumbar Spinal Stenosis guanghui guo, Rongyue Li, Yugao Wu, Xinyu Mao, Zhuo Cheng, Mingwei Luo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6276723/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Objective: This study aims to assess the impact of the Chinese Diagnosis-Related Group(C-DRG) reform on hospitalization costs and length of stay (LOS) in patients with lumbar spinal stenosis (LSS), providing empirical evidence for policy-making. Methods: This study is a retrospective observational study. Data from 914 patients before the implementation of C-DRG and 1,476 patients after its implementation in a medical institution were used. A propensity score matching method was applied to select 1,224 comparable patients for analysis.Independent t-tests and chi-square tests were used for unadjusted comparisons, and generalized linear models (GLMs) were used to assess the adjusted results. Exponential smoothing methods were applied to predict future trends. Results: After the reform, the length of stay in LSS patients significantly decreased (14.28 ±9.92 days vs. 12.14 ± 7.38 days, p < 0.001), while drug costs significantly decreased (p < 0.001). However, examination and treatment service costs increased (p < 0.05). GLM analysis revealed that the C-DRG reform had no significant association with the overall change in hospitalization costs, but had a significant impact on length of stay, drug costs, and diagnostic fees. Trend forecasting suggests that hospitalization costs will remain stable, while the LOS may experience minor fluctuations in the future. Conclusion: The C-DRG reform significantly optimized hospitalization efficiency in LSS patients, reducing drug costs, but attention should be paid to the increasing trend in diagnostic and treatment costs. Ongoing monitoring and improvements in the reform are crucial for achieving an efficient and sustainable healthcare system. Health sciences/Medical research Health sciences/Medical research/Epidemiology Chinese Diagnosis-Related Group (C-DRG) Lumbar Spinal Stenosis (LSS) hospitalization costs length of stay(LOS) drug costs treatment service fees Introduction With the aging population and the increasing burden of chronic diseases, the rapid rise in healthcare costs has posed significant challenges to healthcare resource allocation and the financial burden on patients. To address this issue, the Chinese government has implemented a series of healthcare reform measures in recent years, including the DRG payment reform, which centers on a case-based payment system 1 – 4 . The introduction of C-DRG aims to standardize hospitalization cost reimbursement, enhance healthcare service efficiency, control unnecessary expenses, and promote improvements in medical quality. Its primary goal is to categorize and group patient information, including disease type, treatment methods, and hospitalization costs, in order to establish fee standards that match the severity of the patient’s disease and treatment needs, thereby promoting quality control and cost management in healthcare services 5 – 7 . LSS refers to the narrowing of the lumbar spinal canal due to various causes, which compresses the nerve roots or spinal cord, leading to symptoms such as leg pain, numbness, and difficulty walking 8 . It is common in elderly populations 9 . Clinically, LSS is typically diagnosed through imaging examinations such as X-rays, CT scans, and MRIs. Treatment options for this condition include surgical treatment (e.g., lumbar decompression, spinal fusion) and conservative treatment (e.g., medication, physical therapy) 10 – 13 . Surgical treatment is suitable for patients with severe symptoms that significantly affect quality of life. The goal is to relieve nerve compression and restore spinal stability, but it comes with higher costs, longer hospital stays, and greater surgical risks. Conservative treatment is suitable for patients with mild symptoms or those unwilling to undergo surgery. The aim is to alleviate symptoms and improve the patient’s daily functioning. Conservative treatment generally incurs lower costs and shorter hospital stays, but its effectiveness varies depending on the patient’s condition and tolerance.. Hospitalization costs and LOS for lumbar spinal stenosis are influenced by various factors, including the patient’s age, sex, comorbidities, treatment methods (surgery or conservative treatment), insurance type, and the hospital’s management level. In addition, comorbidities (such as diabetes, hypertension, etc.) can increase treatment costs and length of hospitalization 14 . This study focuses on patients with lumbar spinal stenosis, systematically analyzing changes in hospitalization costs and LOS before and after the implementation of C-DRG, and exploring the practical impact of the reform on healthcare efficiency and cost control. The study uses specific clinical data to evaluate the implementation of the C-DRG reform in a particular disease group (such as patients with lumbar spinal stenosis). It combines the clinical characteristics and treatment needs of the patient population to explore the practical application value of C-DRG in disease management. Through this quantitative analysis, the study not only provides valuable insights for hospital managers but also offers important evidence for policymakers in advancing healthcare reform and optimizing resource allocation. Results Patient Characteristics The basic characteristics of patients before and after the reform showed some changes before and after PSM analysis (Table 1). Comparison of data before (n=914) and after (n=1476) the C-DRG implementation revealed significant differences in hospitalization days, treatment methods, insurance types, and CCI. After the reform, the proportion of URRBMI patients significantly increased (from 47.7% to 86.04%, p<0.001), while the proportion of UEBMI patients significantly decreased (from 52.3% to 13.96%, p<0.001). The proportion of patients receiving surgical treatment decreased from 58.21% to 34.21% (p<0.001), while the proportion receiving conservative treatment increased from 41.79% to 65.79% (p<0.001). In the matched data, the differences between the pre- and post-reform groups became consistent, with no significant changes observed (age: p=0.53, sex: p=0.567, insurance type: p=0.247, treatment method: p=0.389, CCI: p=0.482). These variables were controlled for in the propensity score matching. Table 1 Characteristics of the study population before and after propensity score matching Variables Before matching After matching Before C-DRG (n=914) After C-DRG (n=1476) P a Before C-DRG (n=612) After C-DRG (n=612) P a Age years, mean (SD) 60.00(12.65) 60.34(11.46) 0.491 60.75(12.90) 61.19(11.81) 0.53 Length of stay, mean (SD) 14.28(9.92) 12.14(7.38) 0.000 13.53(8.91) 12.45(9.82) 0.045 b Gender, n (%) 0.206 0.567 Male 441(48.25) 673(45.60) 295(48.20) 285(46.57) Female 473(51.75) 803(54.40) 317(51.80) 327(53.43) b Insurance type, n (%) 0.000 0.247 URRBMI 436(47.70) 1270(86.04) 402(65.69) 421(68.79) UEBMI 478(52.30) 206(13.96) 210(34.31) 191(31.21) b Treatment methods, n (%) 0.000 0.389 Surgical treatment 532(58.21) 505(34.21) 326(53.27) 341(55.72) Conservative treatment 382(41.79) 971(65.79) 286(46.73) 271(44.28) Charlson Comorbidity Index,n(%) 0.037 0.482 ＜3 385(42.12) 686(46.48) 245(40.03) 233(38.07) ≥3 529(57.88) 790(53.52) 367(59.97) 379(61.93) Abbreviations: SD Standard deviation, C-DRG Chinese diagnosis-related group, UEBMI Urban Employee Basic Medical Insurance, URRBMI Urban and Rural Resident Basic Medical Insurance. a Results of independent samples t test for continuous variables and Chi-square tests for categorical variables b These variables were included in the propensity score matching estimators, by giving priority to exact matches Changes in Hospitalization Costs and Length of Stay (Unadjusted Analysis) The unadjusted changes in hospitalization costs and LOS before and after the reform(Table 2). Hospitalization costs and LOS changed before and after the C-DRG reform. Specifically, LOS decreased from 13.53 days before the reform to 12.45 days after the reform (p=0.045), a significant reduction. Drug costs decreased significantly, from 3,234RMB to 2,350RMB (p<0.001). Diagnostic costs increased significantly, from 3,270 RMB to 3,869 RMB (p<0.001). In addition, physician services and treatment costs also increased significantly (from 6,323 RMB to 7,339RMB, p=0.017). However, material costs did not show a significant change (p=0.440), indicating that the impact of the C-DRG reform was more pronounced in other cost categories. Table 2 Unadjusted inpatient expenditures and length of stay before and after C-DRG reform Before C-DRG Mean (SD) After C-DRG Mean (SD) P a Total inpatient expenditure(¥) 23422(24850) 24814(29415) 0.371 Length of stay (days) 13.53(8.91) 12.45(9.82) 0.045 Drug expenditure(¥) 3234(3574) 2350(3697) 0.000 Diagnostic testing expenditure(¥) 3270(1796) 3869(3228) 0.000 Physician services and therapeutic services expenditure(¥) 6323(6563) 7339(8246) 0.017 Material expenditure(¥) 10381(14682) 11084(17062) 0.440 Abbreviations: C-DRG Chinese diagnosis-related group, SD Standard deviation. a Results of independent samples t test Generalized Linear Model (GLM) Analysis To further explore the independent impact of the C-DRG reform on hospitalization costs and LOS, a GLM was used for adjusted analysis(Table 3). The C-DRG reform had a significant impact on total hospitalization costs, drug costs, diagnostic costs, physician service fees, and LOS. After the C-DRG reform, total hospitalization costs decreased by 3.73% (= exp−0.038–1, p>0.05), a relatively small change. Drug costs decreased by 46.15% (= exp−0.619–1, p<0.001), and material costs decreased by 26.43% (= exp−0.307–1, p<0.001), both showing significant reductions. LOS also significantly decreased (β = -0.133, p<0.001), indicating that the C-DRG reform plays a significant role in controlling LOS. For patients aged ≥65, all costs and LOS increased, except for material costs, whereas male patients had lower hospitalization costs, drug costs, diagnostic costs, and material costs (p<0.05). . URRBMI patients had significantly higher hospitalization costs and LOS compared to UEBMI patients (p<0.05). Patients receiving surgical treatment had significantly higher hospitalization costs and LOS (p<0.001), while patients with more comorbidities (CCI≥3) had significantly higher costs and LOS (p<0.05). Table 3 The GLM analysis results of inpatient expenditures and length of stay Variable Ln (Total expenditure) Ln(Drug expenditure) Ln(Diagnostic testing expenditure) Ln(Physician services and therapeutic services expenditure) Ln(Material expenditure) Ln (Length of stay) DRG reform (after vs.before ref ) -0.038(0.035) -0.619(0.0659) *** 0.118(0.0354) ** -0.005(0.040) -0.307(0.069) *** -0.133(0.0287) *** Age (≥65 vs.< 65 ref ) 0.065(0.0502) * 0.229(0.0945) * 0.082(0.0508) 0.085(0.0574) -0.035(0.099) 0.093(0.0412) * Gender (male vs. female ref ) -0.116(0.035) ** -0.150(0.0659) * -0.110(0.0354) ** -0.072(0.040) -0.180(0.069) ** -0.048(0.0287) Insurance types (URRBMI vs. UEBMI ref ) 0.165(0.0386) *** 0.083(0.0728) 0.200(0.0391) *** 0.202(0.0442) *** 0.153(0.0762) * 0.240(0.0317) *** Treatment methods (Conservative treatment vs. Surgical treatment ref ) -2.372(0.0365) * -2.609(0.0687) *** -0.694(0.0369) *** -2.774(0.0417) *** -5.249(0.0719) *** -1.177(0.0299) *** Charlson Comorbidity Index (≥3 vs.< 3 ref ) 0.220(0.0504) *** 0.236(0.0949) * 0.186(0.0510) *** 0.173(0.0576) ** 0.385(0.0994) *** 0.088(0.0413) * Intercept 10.441(0.0429) *** 8.508(0.0809) *** 8.089(0.0435) *** 9.220(0.0491) *** 9.509(0.0847) 2.784(0.0352) *** R-square 0.37 1.314 0.379 0.484 1.44 0.249 Abbreviations: C-DRG Chinese diagnosis-related group, GLM Generalized linear models, ref Reference group,UEBMI Urban Employee Basic Medical Insurance, URRBMI Urban and Rural Resident Basic Medical Insurance Standard errors in parentheses. * p<0.05, **p<0.01, ***p<0.001 Predictive Analysis of Hospitalization Costs and LOS To predict the trends in hospitalization costs and LOS after the implementation of the C-DRG reform, we used exponential smoothing methods for forecasting over the next few quarters (Table 4). The forecasted results showed that the LOS will remain relatively stable over the next few quarters, with an expected LOS of 11.03 days in the fourth quarter of 2025. Changes in hospitalization costs were also relatively stable, with total hospitalization costs expected to be 18,859 RMB in the fourth quarter of 2025, fluctuating between 3,016 RMB and 34,701RMB. Table 4 Exponential smoothing method for forecasting hospitalization days and hospitalization costs Variable Fourth quarter of 2024 First quarter of 2025 Second quarter of 2025 Third quarter of 2025 Fourth quarter of 2025 Length of stay 11.46（9.34,13.58） 10.46（8.34,12.59） 11.01（8.89,13.13） 10.57（8.44,12.69） 11.03（8.91,13.16） Total expenditure 18856（7956,29761） 18859（6534,31183） 18859（5260,32457） 18859（4095,33622） 18859（3016,34701） Discussion The results of this study indicate that the C-DRG reform significantly impacted hospitalization costs and LOS for patients with LSS. Specifically, after the implementation of C-DRG, the LOS significantly decreased from 13.53 days before the reform to 12.45 days (p=0.045). This change suggests that the implementation of C-DRG has improved hospitalization efficiency to some extent, possibly due to optimization in hospital management, treatment plan selection, and resource allocation 15-17 . Additionally, drug costs decreased significantly from 3,233.68 RMB to 2,350.29 RMB (p<0.001), indicating that the C-DRG reform may have promoted the standardization and rationalization of drug use. However, the increase in diagnostic and treatment costs, especially the increase in physician services and treatment costs (p=0.017), also reflects the complexity of medical services. Although drug costs decreased, other cost items (such as diagnostic and treatment services) increased as medical technology and treatment models evolved. This phenomenon suggests that while optimizing medical costs, more refined management and control of related cost items may be required 18-20 . Despite significant control over drug costs achieved through the C-DRG reform, increases in diagnostic and treatment service costs remained significant. The increase in diagnostic costs may be related to higher quality diagnostic tests and the application of advanced technologies, especially when handling complex cases, where hospitals may have added diagnostic procedures to ensure accuracy. The increase in treatment service costs may reflect the enhancement of treatment intensity and personalized management, especially for surgical patients. With advances in surgical techniques and diversified treatment methods, treatment costs naturally rise 21 . This phenomenon also highlights a challenge that the C-DRG reform may face in its implementation: how to balance cost control with the provision of high-quality medical services. As the level of medical services continues to improve, how to ensure that patients receive timely and accurate treatment while achieving reasonable cost control remains an important task in the C-DRG reform 22 . This study further analyzed the impact of patients' basic characteristics on hospitalization costs and LOS. The results showed that factors such as age, sex, insurance type, treatment method, and comorbidities played an important role in changes in hospitalization costs and LOS 23,24 . Patients aged ≥65 had higher hospitalization costs and LOS, which may be related to differences in treatment plans, treatment intensity, medical needs, and physical function during hospitalization. Elderly patients often have more underlying diseases and associated comorbidities, leading them to opt for conservative treatment. Those requiring surgery also need a longer recovery period. Male patients had significantly lower hospitalization costs and length of stay compared to female patients, which may be related to gender differences in disease presentation, treatment choices, and drug use. URRBMI patients had significantly higher hospitalization costs and length of stay compared to UEBMI patients. This may be due to URRBMI patients typically being from low-income urban and rural populations, which may require more medical resource support, and their hospitalization may involve more health management services. Patients undergoing surgery had significantly higher hospitalization costs and LOS compared to those receiving conservative treatment. This result aligns with the fact that surgical treatments typically require more complex procedures, longer hospital stays, and higher treatment costs 25,26 . Patients with a CCI≥3 had significantly higher hospitalization costs and LOS, suggesting that patients with more comorbidities typically require more medical interventions and nursing care, thus increasing hospitalization costs and duration. There were significant differences in hospitalization costs and LOS between surgical and conservative treatments. Patients receiving surgical treatment had significantly higher hospitalization costs and LOS compared to those receiving conservative treatment 27,28 . This is related to the fact that surgical treatment typically requires more resource input. Surgical patients have higher treatment intensity, and postoperative care and recovery management typically require longer hospitalization and more medical interventions 29-31 .The implementation of the C-DRG reform has encouraged hospitals to optimize hospitalization management, but for patients requiring surgery, ensuring treatment quality while controlling costs remains an issue that warrants attention. Research Methods Study Design This study retrospectively analyzes the changes in hospitalization costs and LOS in patients with lumbar spinal stenosis before and after the C-DRG reform, exploring its impact on patient hospitalization management and treatment efficiency. Data were sourced from the hospital's HIS system, covering a 10-year period (2015–2024) of hospitalized LSS patients. The study analyzed hospitalization costs, LOS, treatment methods, and other related indicators. This study complied with the tenets of the Nuremberg Code/ Declaration of Helsinki/ China Measures for Ethical Review of Biomedical Research Involving People (2016) etc. Because this study was conducted retrospectively with fully anonymized patient data obtained from hospital electronic medical records, informed consent could be exempted after review by the Scientific Research Ethics Committee of Panzhihua Central Hospital(Approval No. 2025-003). Data Sources and Sample Inclusion criteria: Hospitalized patients diagnosed with LSS; aged 18 or older; complete medical records during hospitalization, including basic information, hospitalization costs, LOS, treatment methods, etc.; no severe cognitive impairments or inability to cooperate with data collection 32 . Exclusion criteria: Patients with severe comorbidities or acute conditions; patients who only received outpatient treatment; patients with incomplete data (e.g., missing hospitalization costs or LOS data); patients participating in experimental treatments or receiving unusual treatment plans. Grouping of the study and control groups: The pre-C-DRG group includes LSS patients hospitalized during the 5 years before the implementation of the C-DRG reform (2015–2019, n=914). The post-C-DRG group includes LSS patients hospitalized during the 5 years after the implementation of the C-DRG reform (2020–2024, n=1476). The propensity score matching (PSM) method was used to match patients from both pre- and post-reform groups, resulting in paired data (n=612) to reduce baseline characteristic differences and ensure the fairness of the comparison 33 . Data Collection and Variable Definition Primary variables: Total costs include all expenses incurred during hospitalization, such as drug costs, diagnostic costs, nursing costs, and hospitalization service fees; drug costs refer to all expenses related to patient medication; diagnostic costs refer to expenses associated with diagnostic tests; physician service fees refer to the costs of services provided by medical personnel, such as surgical fees and consultation fees. LOS refers to the number of days from admission to discharge. Demographic characteristics include the patient's age, sex, insurance type, and other basic information. Influencing factors include the patient's age (<65 or ≥65), sex (male or female), insurance type (UEBMI or URRBMI), and treatment method (surgical or conservative treatment). Charlson Comorbidity Index (CCI): Assesses the severity of comorbidities and impacts hospitalization costs and length of stay 34,35 . Statistical Analysis Methods Statistical descriptions of patient characteristics were performed, including demographic features, treatment methods, hospitalization costs, and LOS. Independent t-tests were used to compare continuous variables (e.g., hospitalization costs, LOS) between the two groups; chi-square tests were used for categorical variables (e.g., sex, insurance type). The GLM model were used to analyze the impact of the C-DRG reform on various costs (e.g., total costs, drug costs, physician service fees) and LOS 36 . The GLM model allows for controlling potential confounding factors (e.g., age, sex, treatment methods), thereby providing a more precise assessment of the reform's impact 37 . Exponential smoothing methods were used to predict future hospitalization costs and LOS. Based on historical data, the exponential smoothing model was used to forecast future trends, helping hospitals allocate resources and prepare budgets under the future C-DRG payment system. Limitations of the Study This study has some limitations. First, the data came from a single hospital and employed a retrospective cohort design, which may introduce selection bias, and the generalizability of the results is limited by regional and sample selection factors. Secondly, this study focused only on short-term indicators such as hospitalization costs and length of stay, without considering patients' long-term prognosis and quality of life. Due to the lack of follow-up data, the impact of the C-DRG reform on patients' long-term health status could not be assessed, which is an area that requires further exploration in future studies. Clinical Significance and Policy Recommendations The results of this study provide important insights into the application of the C-DRG reform for patients with LSS. While the reform has achieved some success in controlling LOS and drug costs, challenges remain in controlling diagnostic and treatment costs. Based on the study results, we recommend that hospitals further strengthen the rational allocation of medical resources, particularly in managing and controlling high-cost items (such as diagnostic tests and treatment services). At the same time, hospitals can integrate the C-DRG reform with optimization of hospitalization management strategies and promote the standardization of treatment plans to further improve treatment efficiency. From a public health policy perspective, the C-DRG reform offers an opportunity to optimize the allocation of medical resources and improve the quality of care. When promoting similar reforms, the government should consider the needs of different patient groups and develop more flexible policies to ensure that the reform balances cost control with improved treatment quality, thereby maximizing the overall effectiveness of healthcare services. Conclusion The C-DRG reform significantly reduced the LOS and drug costs for patients with LSS. Specifically, after the implementation of C-DRG, the LOS for patients decreased significantly from 13.53 days to 12.45 days, and drug costs decreased from 3,233.68 RMB to 2,350.29 RMB. However, other treatment costs, such as diagnostic and treatment service fees, showed varying degrees of increase. The increase in diagnostic testing and treatment service fees, in particular, suggests that the reform may have prompted hospitals to invest more in medical interventions and resources for complex cases while ensuring treatment quality. This study provides empirical evidence for further optimizing the C-DRG reform policy. Through a comparative analysis of patients with lumbar spinal stenosis before and after the C-DRG reform, this study reveals the actual effects of the reform on hospitalization management and medical cost control, providing data support for policy improvement. Furthermore, this study provides important references for the rational allocation of hospital resources and decision-making regarding patient treatment methods. Key issues for future healthcare management and public health policy improvements include how to ensure the quality of medical services while controlling costs and how to optimize the cost structure of different treatment methods. Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board (IRB) of Panzhihua Central Hospital (Ethics number:2025-003). All methods were carried out in accordance with relevant guidelines and regulations (in compliance with:Nuremberg Code/Declaration of Helsinki/China Measures for Ethical Review of Biomedical Research Involving People (2016) etc. ) This retrospective study utilized fully anonymized patient data obtained from hospital electronic medical records. The Panzhihua Central Hospital IRB (Approval No. 2025-003) determined that informed consent was not required due to the anonymous nature of the data and the observational design of the study. Data availability Data supporting the findings of this study are available within the paper and its Supplementary Information. Author contributions GHG and RYL contributed equally to this work. GHG and RYLwrote the manuscript and conducted statistical analysis. YGW、XYM and ZC searched the data. MWL designed the study, and revised the manuscript. All authors read and approved the final manuscript. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Competing interests The authors declare no competing interests. References Liu, R. et al. Charting a path forward: policy analysis of China's evolved DRG-based hospital payment system. Int. Health . 9 , 317–324. 10.1093/inthealth/ihx030 (2017). Jian, W. et al. 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Costs and cost-effectiveness of carotid stenting versus endarterectomy for patients at increased surgical risk: results from the SAPPHIRE trial. Catheter Cardiovasc. Interv . 77 , 463–472. 10.1002/ccd.22869 (2011). Kim, C. H. et al. Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: a nationwide matched cohort study with a 10-year follow-up. PLoS One . 16 , e0260460. 10.1371/journal.pone.0260460 (2021). Jensen, R. K. et al. Surgical trends and regional variation in Danish patients diagnosed with lumbar spinal stenosis between 2002 and 2018: a retrospective registry-based study of 83,783 patients. BMC Health Serv. Res. 23 , 665. 10.1186/s12913-023-09638-7 (2023). Drazin, D., Shweikeh, F., Lagman, C., Ugiliweneza, B. & Boakye, M. Racial disparities in elderly patients receiving lumbar spinal stenosis surgery. Global Spine J. 7 , 162–169. 10.1177/2192568217694012 (2017). Yang, Y. et al. Managing urban stroke health expenditures in China: role of payment method and hospital level. Int. J. Health Policy Manag . 11 , 2698–2706. 10.34172/ijhpm.2022.5117 (2022). Hu, H. et al. Medical insurance payment schemes and patient medical expenses: a cross-sectional study of lung cancer patients in urban China. BMC Health Serv. Res. 23 10.1186/s12913-023-09078-3 (2023). Meng, Z., Zhu, M., Cai, Y., Cao, X. & Wu, H. Effect of a typical systemic hospital reform on inpatient expenditure for rural population: the Sanming model in China. BMC Health Serv. Res. 19 , 231. 10.1186/s12913-019-4048-7 (2019). Martin, B. I. et al. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa. 1976) . 44 , 369–376. 10.1097/brs.0000000000002822 (2019). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 15 May, 2026 Reviewers agreed at journal 05 May, 2026 Reviewers agreed at journal 10 Aug, 2025 Reviewers invited by journal 13 Jul, 2025 Editor assigned by journal 10 Jul, 2025 Editor invited by journal 01 Apr, 2025 Submission checks completed at journal 01 Apr, 2025 First submitted to journal 21 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6276723","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":484826427,"identity":"e0173515-4c14-4712-a216-2e80a28cfcfa","order_by":0,"name":"guanghui guo","email":"","orcid":"","institution":"Panzhihua Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"guanghui","middleName":"","lastName":"guo","suffix":""},{"id":484826428,"identity":"218dfbbb-61fe-4eee-83e0-36674c1cab26","order_by":1,"name":"Rongyue Li","email":"","orcid":"","institution":"Panzhihua Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rongyue","middleName":"","lastName":"Li","suffix":""},{"id":484826429,"identity":"55f14330-a8d4-4511-add1-94326dd62e83","order_by":2,"name":"Yugao Wu","email":"","orcid":"","institution":"Panzhihua Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yugao","middleName":"","lastName":"Wu","suffix":""},{"id":484826430,"identity":"a0038605-6ff9-437f-9632-5eecc8933d3c","order_by":3,"name":"Xinyu Mao","email":"","orcid":"","institution":"Panzhihua Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xinyu","middleName":"","lastName":"Mao","suffix":""},{"id":484826431,"identity":"00af2520-9fd4-44a3-b0c2-b7663ddb7be3","order_by":4,"name":"Zhuo Cheng","email":"","orcid":"","institution":"Panzhihua Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhuo","middleName":"","lastName":"Cheng","suffix":""},{"id":484826432,"identity":"0ed96ae6-3227-4b30-8132-c5fb3ce54d7f","order_by":5,"name":"Mingwei Luo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArUlEQVRIiWNgGAWjYBACPgYGxgcfftjw8PM3EKmFjYGB2XBmT5qM5IwDxGthk+ZhO2xj0JBArBaxM8YGPDzneQwYDjB++JhDjBbpHMMHEha3ecyZG5glZ24jSkvuZgMDnts8lg0H2Jh5idSyTSKB7RyPwYEEUrQcYDtAkpb8z4aNPck8kjMONhPnF37ptMTHf37Y2fPzNx/88JEYLUiAsYE09aNgFIyCUTAKcAMA+IoxtYSrBOIAAAAASUVORK5CYII=","orcid":"","institution":"Panzhihua Central Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mingwei","middleName":"","lastName":"Luo","suffix":""}],"badges":[],"createdAt":"2025-03-21 10:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6276723/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6276723/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86861112,"identity":"333df154-67e8-4e1d-876f-697c5e5082dc","added_by":"auto","created_at":"2025-07-16 12:17:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":758314,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6276723/v1/97fe9134-c7ab-418c-be10-1384b0afa2ac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the Impact of C-DRG Reform on Hospitalization Costs and Length of Stay in Patients with Lumbar Spinal Stenosis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the aging population and the increasing burden of chronic diseases, the rapid rise in healthcare costs has posed significant challenges to healthcare resource allocation and the financial burden on patients. To address this issue, the Chinese government has implemented a series of healthcare reform measures in recent years, including the DRG payment reform, which centers on a case-based payment system\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. The introduction of C-DRG aims to standardize hospitalization cost reimbursement, enhance healthcare service efficiency, control unnecessary expenses, and promote improvements in medical quality. Its primary goal is to categorize and group patient information, including disease type, treatment methods, and hospitalization costs, in order to establish fee standards that match the severity of the patient\u0026rsquo;s disease and treatment needs, thereby promoting quality control and cost management in healthcare services\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eLSS refers to the narrowing of the lumbar spinal canal due to various causes, which compresses the nerve roots or spinal cord, leading to symptoms such as leg pain, numbness, and difficulty walking\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. It is common in elderly populations\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Clinically, LSS is typically diagnosed through imaging examinations such as X-rays, CT scans, and MRIs. Treatment options for this condition include surgical treatment (e.g., lumbar decompression, spinal fusion) and conservative treatment (e.g., medication, physical therapy)\u003csup\u003e\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Surgical treatment is suitable for patients with severe symptoms that significantly affect quality of life. The goal is to relieve nerve compression and restore spinal stability, but it comes with higher costs, longer hospital stays, and greater surgical risks. Conservative treatment is suitable for patients with mild symptoms or those unwilling to undergo surgery. The aim is to alleviate symptoms and improve the patient\u0026rsquo;s daily functioning. Conservative treatment generally incurs lower costs and shorter hospital stays, but its effectiveness varies depending on the patient\u0026rsquo;s condition and tolerance.. Hospitalization costs and LOS for lumbar spinal stenosis are influenced by various factors, including the patient\u0026rsquo;s age, sex, comorbidities, treatment methods (surgery or conservative treatment), insurance type, and the hospital\u0026rsquo;s management level. In addition, comorbidities (such as diabetes, hypertension, etc.) can increase treatment costs and length of hospitalization\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study focuses on patients with lumbar spinal stenosis, systematically analyzing changes in hospitalization costs and LOS before and after the implementation of C-DRG, and exploring the practical impact of the reform on healthcare efficiency and cost control. The study uses specific clinical data to evaluate the implementation of the C-DRG reform in a particular disease group (such as patients with lumbar spinal stenosis). It combines the clinical characteristics and treatment needs of the patient population to explore the practical application value of C-DRG in disease management. Through this quantitative analysis, the study not only provides valuable insights for hospital managers but also offers important evidence for policymakers in advancing healthcare reform and optimizing resource allocation.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe basic characteristics of patients before and after the reform showed some changes before and after PSM analysis (Table 1). Comparison of data before (n=914) and after (n=1476) the C-DRG implementation revealed significant differences in hospitalization days, treatment methods, insurance types, and CCI. After the reform, the proportion of URRBMI patients significantly increased (from 47.7% to 86.04%, p\u0026lt;0.001), while the proportion of UEBMI patients significantly decreased (from 52.3% to 13.96%, p\u0026lt;0.001). The proportion of patients receiving surgical treatment decreased from 58.21% to 34.21% (p\u0026lt;0.001), while the proportion receiving conservative treatment increased from 41.79% to 65.79% (p\u0026lt;0.001). In the matched data, the differences between the pre- and post-reform groups became consistent, with no significant changes observed (age: p=0.53, sex: p=0.567, insurance type: p=0.247, treatment method: p=0.389, CCI: p=0.482). These variables were controlled for in the propensity score matching.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eCharacteristics of the study population before and after propensity score matching\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"596\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 145px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 213px;\"\u003e\n \u003cp\u003eBefore matching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 222px;\"\u003e\n \u003cp\u003eAfter matching\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eBefore C-DRG\u003c/p\u003e\n \u003cp\u003e(n=914)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eAfter C-DRG (n=1476)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eBefore C-DRG\u0026nbsp;(n=612)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eAfter C-DRG (n=612)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eAge years, mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e60.00(12.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e60.34(11.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e60.75(12.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e61.19(11.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eLength of stay, mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e14.28(9.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e12.14(7.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e13.53(8.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e12.45(9.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eGender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.567\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e441(48.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e673(45.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e295(48.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e285(46.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e473(51.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e803(54.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e317(51.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e327(53.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eInsurance type, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eURRBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e436(47.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e1270(86.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e402(65.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e421(68.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eUEBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e478(52.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e206(13.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e210(34.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e191(31.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eTreatment methods, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eSurgical treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e532(58.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e505(34.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e326(53.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e341(55.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eConservative treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e382(41.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e971(65.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e286(46.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e271(44.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eCharlson Comorbidity Index,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.482\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e385(42.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e686(46.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e245(40.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e233(38.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e529(57.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e790(53.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e367(59.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e379(61.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: SD Standard deviation, C-DRG Chinese diagnosis-related group, UEBMI Urban Employee Basic Medical Insurance, URRBMI Urban and Rural Resident Basic Medical Insurance.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eResults of independent samples t test for continuous variables and Chi-square tests for categorical variables\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003eThese variables were included in the propensity score matching estimators, by giving priority to exact matches\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChanges in Hospitalization Costs and Length of Stay (Unadjusted Analysis)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe unadjusted changes in hospitalization costs and LOS before and after the reform(Table 2). Hospitalization costs and LOS changed before and after the C-DRG reform. Specifically, LOS decreased from 13.53 days before the reform to 12.45 days after the reform (p=0.045), a significant reduction. Drug costs decreased significantly, from 3,234RMB to 2,350RMB (p\u0026lt;0.001). Diagnostic costs increased significantly, from 3,270 RMB to 3,869 RMB (p\u0026lt;0.001). In addition, physician services and treatment costs also increased significantly (from 6,323 RMB to 7,339RMB, p=0.017). However, material costs did not show a significant change (p=0.440), indicating that the impact of the C-DRG reform was more pronounced in other cost categories.\u003c/p\u003e\n\u003cp\u003eTable 2 Unadjusted inpatient expenditures and length of stay before and after C-DRG reform\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"536\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eBefore C-DRG Mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003eAfter C-DRG Mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003eP\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eTotal inpatient expenditure(\u0026yen;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e23422(24850)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e24814(29415)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eLength of stay (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e13.53(8.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e12.45(9.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eDrug expenditure(\u0026yen;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e3234(3574)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e2350(3697)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eDiagnostic testing expenditure(\u0026yen;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e3270(1796)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e3869(3228)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003ePhysician services and therapeutic services expenditure(\u0026yen;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e6323(6563)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e7339(8246)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eMaterial expenditure(\u0026yen;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e10381(14682)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e11084(17062)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.440\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: C-DRG Chinese diagnosis-related group, SD Standard deviation.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eResults of independent samples t test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneralized Linear Model (GLM) Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo further explore the independent impact of the C-DRG reform on hospitalization costs and LOS, a GLM was used for adjusted analysis(Table 3). The C-DRG reform had a significant impact on total hospitalization costs, drug costs, diagnostic costs, physician service fees, and LOS. \u0026nbsp;After the C-DRG reform, total hospitalization costs decreased by 3.73% (= exp\u0026minus;0.038\u0026ndash;1, p\u0026gt;0.05), a relatively small change. Drug costs decreased by 46.15% (= exp\u0026minus;0.619\u0026ndash;1, p\u0026lt;0.001), and material costs decreased by 26.43% (= exp\u0026minus;0.307\u0026ndash;1, p\u0026lt;0.001), both showing significant reductions. LOS also significantly decreased (\u0026beta;\u0026nbsp;= -0.133, p\u0026lt;0.001), indicating that the C-DRG reform plays a significant role in controlling LOS. For patients aged\u0026nbsp;\u0026ge;65, all costs and LOS increased, except for material costs, whereas male patients had lower hospitalization costs, drug costs, diagnostic costs, and material costs (p\u0026lt;0.05). . URRBMI patients had significantly higher hospitalization costs and LOS compared to UEBMI patients (p\u0026lt;0.05). Patients receiving surgical treatment had significantly higher hospitalization costs and LOS (p\u0026lt;0.001), while patients with more comorbidities (CCI\u0026ge;3) had significantly higher costs and LOS (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eTable 3 The GLM analysis results of inpatient expenditures and length of stay\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"769\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eLn (Total expenditure)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003eLn(Drug expenditure)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eLn(Diagnostic testing expenditure)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eLn(Physician services and therapeutic services expenditure)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003eLn(Material expenditure)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eLn (Length of stay)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003col\u003e\n \u003cli\u003eDRG reform\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;(after vs.before\u003csup\u003eref\u003c/sup\u003e)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e-0.038(0.035)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e-0.619(0.0659)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0.118(0.0354)\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e-0.005(0.040)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e-0.307(0.069)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e-0.133(0.0287)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eAge (\u0026ge;65 vs.\u0026lt; 65\u003csup\u003eref\u003c/sup\u003e )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0.065(0.0502)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.229(0.0945)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0.082(0.0508)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0.085(0.0574)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e-0.035(0.099)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.093(0.0412)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eGender (male vs. female\u003csup\u003eref\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e-0.116(0.035)\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e-0.150(0.0659)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e-0.110(0.0354)\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e-0.072(0.040)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e-0.180(0.069)\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e-0.048(0.0287)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eInsurance types\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(URRBMI vs. UEBMI\u003csup\u003eref\u003c/sup\u003e )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0.165(0.0386)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.083(0.0728)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0.200(0.0391)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0.202(0.0442)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.153(0.0762)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.240(0.0317)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eTreatment methods\u003c/p\u003e\n \u003cp\u003e(Conservative treatment vs. Surgical treatment \u003csup\u003eref\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e-2.372(0.0365)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e-2.609(0.0687)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e-0.694(0.0369)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e-2.774(0.0417)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e-5.249(0.0719)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e-1.177(0.0299)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eCharlson Comorbidity Index\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026ge;3 vs.\u0026lt; 3\u003csup\u003eref\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0.220(0.0504)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.236(0.0949)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0.186(0.0510)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0.173(0.0576)\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0.385(0.0994)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.088(0.0413)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e10.441(0.0429)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e8.508(0.0809)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e8.089(0.0435)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e9.220(0.0491)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e9.509(0.0847)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e2.784(0.0352)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eR-square\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e1.314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: C-DRG Chinese diagnosis-related group, GLM Generalized linear models, ref Reference group,UEBMI Urban Employee Basic Medical Insurance, URRBMI Urban and Rural Resident Basic Medical Insurance\u003c/p\u003e\n\u003cp\u003eStandard errors in parentheses. * p\u0026lt;0.05, **p\u0026lt;0.01, ***p\u0026lt;0.001\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictive Analysis of Hospitalization Costs and LOS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo predict the trends in hospitalization costs and LOS after the implementation of the C-DRG reform, we used exponential smoothing methods for forecasting over the next few quarters (Table 4). The forecasted results showed that the LOS will remain relatively stable over the next few quarters, with an expected LOS of 11.03 days in the fourth quarter of 2025. Changes in hospitalization costs were also relatively stable, with total hospitalization costs expected to be 18,859 RMB in the fourth quarter of 2025, fluctuating between 3,016 RMB and 34,701RMB.\u003c/p\u003e\n\u003cp\u003eTable 4 Exponential smoothing method for forecasting hospitalization days and hospitalization costs\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003eFourth quarter of 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003eFirst quarter of 2025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eSecond quarter of 2025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003eThird quarter of 2025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003eFourth quarter of 2025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eLength of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e11.46（9.34,13.58）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e10.46（8.34,12.59）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e11.01（8.89,13.13）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e10.57（8.44,12.69）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e11.03（8.91,13.16）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eTotal expenditure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e18856（7956,29761）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e18859（6534,31183）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e18859（5260,32457）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e18859（4095,33622）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e18859（3016,34701）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study indicate that the C-DRG reform significantly impacted hospitalization costs and LOS for patients with LSS. Specifically, after the implementation of C-DRG, the LOS significantly decreased from 13.53 days before the reform to 12.45 days (p=0.045). This change suggests that the implementation of C-DRG has improved hospitalization efficiency to some extent, possibly due to optimization in hospital management, treatment plan selection, and resource allocation\u003csup\u003e15-17\u003c/sup\u003e. Additionally, drug costs decreased significantly from 3,233.68 RMB to 2,350.29 RMB (p\u0026lt;0.001), indicating that the C-DRG reform may have promoted the standardization and rationalization of drug use. However, the increase in diagnostic and treatment costs, especially the increase in physician services and treatment costs (p=0.017), also reflects the complexity of medical services. Although drug costs decreased, other cost items (such as diagnostic and treatment services) increased as medical technology and treatment models evolved. This phenomenon suggests that while optimizing medical costs, more refined management and control of related cost items may be required\u003csup\u003e18-20\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eDespite significant control over drug costs achieved through the C-DRG reform, increases in diagnostic and treatment service costs remained significant. The increase in diagnostic costs may be related to higher quality diagnostic tests and the application of advanced technologies, especially when handling complex cases, where hospitals may have added diagnostic procedures to ensure accuracy. The increase in treatment service costs may reflect the enhancement of treatment intensity and personalized management, especially for surgical patients. With advances in surgical techniques and diversified treatment methods, treatment costs naturally rise\u003csup\u003e21\u003c/sup\u003e. This phenomenon also highlights a challenge that the C-DRG reform may face in its implementation: how to balance cost control with the provision of high-quality medical services. As the level of medical services continues to improve, how to ensure that patients receive timely and accurate treatment while achieving reasonable cost control remains an important task in the C-DRG reform\u003csup\u003e22\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThis study further analyzed the impact of patients' basic characteristics on hospitalization costs and LOS. The results showed that factors such as age, sex, insurance type, treatment method, and comorbidities played an important role in changes in hospitalization costs and LOS\u003csup\u003e23,24\u003c/sup\u003e. Patients aged\u0026nbsp;≥65 had higher hospitalization costs and LOS, which may be related to differences in treatment plans, treatment intensity, medical needs, and physical function during hospitalization. Elderly patients often have more underlying diseases and associated comorbidities, leading them to opt for conservative treatment. Those requiring surgery also need a longer recovery period. Male patients had significantly lower hospitalization costs and length of stay compared to female patients, which may be related to gender differences in disease presentation, treatment choices, and drug use.\u003c/p\u003e\n\u003cp\u003eURRBMI patients had significantly higher hospitalization costs and length of stay compared to UEBMI patients. This may be due to URRBMI patients typically being from low-income urban and rural populations, which may require more medical resource support, and their hospitalization may involve more health management services. Patients undergoing surgery had significantly higher hospitalization costs and LOS compared to those receiving conservative treatment. This result aligns with the fact that surgical treatments typically require more complex procedures, longer hospital stays, and higher treatment costs\u003csup\u003e25,26\u003c/sup\u003e. Patients with a CCI≥3 had significantly higher hospitalization costs and LOS, suggesting that patients with more comorbidities typically require more medical interventions and nursing care, thus increasing hospitalization costs and duration.\u003c/p\u003e\n\u003cp\u003eThere were significant differences in hospitalization costs and LOS between surgical and conservative treatments. Patients receiving surgical treatment had significantly higher hospitalization costs and LOS compared to those receiving conservative treatment\u003csup\u003e27,28\u003c/sup\u003e. This is related to the fact that surgical treatment typically requires more resource input. Surgical patients have higher treatment intensity, and postoperative care and recovery management typically require longer hospitalization and more medical interventions\u003csup\u003e29-31\u003c/sup\u003e.The implementation of the C-DRG reform has encouraged hospitals to optimize hospitalization management, but for patients requiring surgery, ensuring treatment quality while controlling costs remains an issue that warrants attention.\u003c/p\u003e"},{"header":"Research Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study retrospectively analyzes the changes in hospitalization costs and LOS in patients with lumbar spinal stenosis before and after the C-DRG reform, exploring its impact on patient hospitalization management and treatment efficiency. Data were sourced from the hospital\u0026apos;s HIS system, covering a 10-year period (2015\u0026ndash;2024) of hospitalized LSS patients. The study analyzed hospitalization costs, LOS, treatment methods, and other related indicators. This study complied with the tenets of the Nuremberg Code/ Declaration of Helsinki/ China Measures for Ethical Review of Biomedical Research Involving People (2016) etc. Because this study was conducted retrospectively with fully anonymized patient data obtained from hospital electronic medical records, informed consent could be exempted after review by the Scientific Research Ethics Committee of Panzhihua Central Hospital(Approval No. 2025-003).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Sources and Sample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion criteria: Hospitalized patients diagnosed with LSS; aged 18 or older; complete medical records during hospitalization, including basic information, hospitalization costs, LOS, treatment methods, etc.; no severe cognitive impairments or inability to cooperate with data collection\u003csup\u003e32\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: Patients with severe comorbidities or acute conditions; patients who only received outpatient treatment; patients with incomplete data (e.g., missing hospitalization costs or LOS data); patients participating in experimental treatments or receiving unusual treatment plans.\u003c/p\u003e\n\u003cp\u003eGrouping of the study and control groups: The pre-C-DRG group includes LSS patients hospitalized during the 5 years before the implementation of the C-DRG reform (2015\u0026ndash;2019, n=914). The post-C-DRG group includes LSS patients hospitalized during the 5 years after the implementation of the C-DRG reform (2020\u0026ndash;2024, n=1476). The propensity score matching (PSM) method was used to match patients from both pre- and post-reform groups, resulting in paired data (n=612) to reduce baseline characteristic differences and ensure the fairness of the comparison\u003csup\u003e33\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection and Variable Definition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary variables: Total costs include all expenses incurred during hospitalization, such as drug costs, diagnostic costs, nursing costs, and hospitalization service fees; drug costs refer to all expenses related to patient medication; diagnostic costs refer to expenses associated with diagnostic tests; physician service fees refer to the costs of services provided by medical personnel, such as surgical fees and consultation fees. LOS refers to the number of days from admission to discharge. Demographic characteristics include the patient\u0026apos;s age, sex, insurance type, and other basic information. Influencing factors include the patient\u0026apos;s age (\u0026lt;65 or\u0026nbsp;\u0026ge;65), sex (male or female), insurance type (UEBMI or URRBMI), and treatment method (surgical or conservative treatment). Charlson Comorbidity Index (CCI): Assesses the severity of comorbidities and impacts hospitalization costs and length of stay\u003csup\u003e34,35\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical descriptions of patient characteristics were performed, including demographic features, treatment methods, hospitalization costs, and LOS. Independent t-tests were used to compare continuous variables (e.g., hospitalization costs, LOS) between the two groups; chi-square tests were used for categorical variables (e.g., sex, insurance type). The GLM model were used to analyze the impact of the C-DRG reform on various costs (e.g., total costs, drug costs, physician service fees) and LOS\u003csup\u003e36\u003c/sup\u003e. The GLM model allows for controlling potential confounding factors (e.g., age, sex, treatment methods), thereby providing a more precise assessment of the reform\u0026apos;s impact\u003csup\u003e37\u003c/sup\u003e. Exponential smoothing methods were used to predict future hospitalization costs and LOS. Based on historical data, the exponential smoothing model was used to forecast future trends, helping hospitals allocate resources and prepare budgets under the future C-DRG payment system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has some limitations. First, the data came from a single hospital and employed a retrospective cohort design, which may introduce selection bias, and the generalizability of the results is limited by regional and sample selection factors. Secondly, this study focused only on short-term indicators such as hospitalization costs and length of stay, without considering patients\u0026apos; long-term prognosis and quality of life. Due to the lack of follow-up data, the impact of the C-DRG reform on patients\u0026apos; long-term health status could not be assessed, which is an area that requires further exploration in future studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Significance and Policy Recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study provide important insights into the application of the C-DRG reform for patients with LSS. While the reform has achieved some success in controlling LOS and drug costs, challenges remain in controlling diagnostic and treatment costs. Based on the study results, we recommend that hospitals further strengthen the rational allocation of medical resources, particularly in managing and controlling high-cost items (such as diagnostic tests and treatment services). At the same time, hospitals can integrate the C-DRG reform with optimization of hospitalization management strategies and promote the standardization of treatment plans to further improve treatment efficiency. From a public health policy perspective, the C-DRG reform offers an opportunity to optimize the allocation of medical resources and improve the quality of care. When promoting similar reforms, the government should consider the needs of different patient groups and develop more flexible policies to ensure that the reform balances cost control with improved treatment quality, thereby maximizing the overall effectiveness of healthcare services.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe C-DRG reform significantly reduced the LOS and drug costs for patients with LSS. Specifically, after the implementation of C-DRG, the LOS for patients decreased significantly from 13.53 days to 12.45 days, and drug costs decreased from 3,233.68 RMB to 2,350.29 RMB. However, other treatment costs, such as diagnostic and treatment service fees, showed varying degrees of increase. The increase in diagnostic testing and treatment service fees, in particular, suggests that the reform may have prompted hospitals to invest more in medical interventions and resources for complex cases while ensuring treatment quality. This study provides empirical evidence for further optimizing the C-DRG reform policy. Through a comparative analysis of patients with lumbar spinal stenosis before and after the C-DRG reform, this study reveals the actual effects of the reform on hospitalization management and medical cost control, providing data support for policy improvement. Furthermore, this study provides important references for the rational allocation of hospital resources and decision-making regarding patient treatment methods. Key issues for future healthcare management and public health policy improvements include how to ensure the quality of medical services while controlling costs and how to optimize the cost structure of different treatment methods.\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 approved by the Institutional Review Board (IRB) of Panzhihua Central Hospital (Ethics number:2025-003). All methods were carried out in accordance with relevant guidelines and regulations (in compliance with:Nuremberg Code/Declaration of Helsinki/China Measures for Ethical Review of Biomedical Research Involving People (2016) etc. )\u003c/p\u003e\n\u003cp\u003eThis retrospective study utilized fully anonymized patient data obtained from hospital electronic medical records. The Panzhihua Central Hospital IRB (Approval No. 2025-003) determined that informed consent was not required due to the anonymous nature of the data and the observational design of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData supporting the findings of this study are available within the paper and its Supplementary Information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGHG and RYL contributed equally to this work. GHG and RYLwrote the manuscript and conducted statistical analysis. YGW、XYM and ZC searched the data. MWL designed the study, and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLiu, R. et al. Charting a path forward: policy analysis of China's evolved DRG-based hospital payment system. \u003cem\u003eInt. 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Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. \u003cem\u003eSpine (Phila Pa. 1976)\u003c/em\u003e. \u003cb\u003e44\u003c/b\u003e, 369\u0026ndash;376. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/brs.0000000000002822\u003c/span\u003e\u003cspan address=\"10.1097/brs.0000000000002822\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e\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":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chinese Diagnosis-Related Group (C-DRG), Lumbar Spinal Stenosis (LSS), hospitalization costs, length of stay(LOS), drug costs, treatment service fees","lastPublishedDoi":"10.21203/rs.3.rs-6276723/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6276723/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aims to assess the impact of the Chinese Diagnosis-Related Group(C-DRG) reform on hospitalization costs and length of stay (LOS) in patients with lumbar spinal stenosis (LSS), providing empirical evidence for policy-making.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study is a retrospective observational study. Data from 914 patients before the implementation of C-DRG and 1,476 patients after its implementation in a medical institution were used. A propensity score matching method was applied to select 1,224 comparable patients for analysis.Independent t-tests and chi-square tests were used for unadjusted comparisons, and generalized linear models (GLMs) were used to assess the adjusted results. Exponential smoothing methods were applied to predict future trends.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eAfter the reform, the length of stay in LSS patients significantly decreased (14.28 ±9.92 days vs. 12.14 ± 7.38 days, p \u0026lt; 0.001), while drug costs significantly decreased (p \u0026lt; 0.001). However, examination and treatment service costs increased (p \u0026lt; 0.05). GLM analysis revealed that the C-DRG reform had no significant association with the overall change in hospitalization costs, but had a significant impact on length of stay, drug costs, and diagnostic fees. Trend forecasting suggests that hospitalization costs will remain stable, while the LOS may experience minor fluctuations in the future.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe C-DRG reform significantly optimized hospitalization efficiency in LSS patients, reducing drug costs, but attention should be paid to the increasing trend in diagnostic and treatment costs. Ongoing monitoring and improvements in the reform are crucial for achieving an efficient and sustainable healthcare system.\u003c/p\u003e","manuscriptTitle":"Analysis of the Impact of C-DRG Reform on Hospitalization Costs and Length of Stay in Patients with Lumbar Spinal Stenosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-16 12:08:48","doi":"10.21203/rs.3.rs-6276723/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-15T18:04:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208171901664667432584551722347283813881","date":"2026-05-05T18:13:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"219444744129023115720059064842063402216","date":"2025-08-10T19:21:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-14T02:54:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-10T17:46:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-01T13:38:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-01T05:10:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-03-21T10:25:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c4052e8c-fc1a-4f4d-b6df-bb7a9d7f9c53","owner":[],"postedDate":"July 16th, 2025","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-15T18:04:51+00:00","index":192,"fulltext":""},{"type":"reviewerAgreed","content":"208171901664667432584551722347283813881","date":"2026-05-05T18:13:24+00:00","index":189,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":51463682,"name":"Health sciences/Medical research"},{"id":51463683,"name":"Health sciences/Medical research/Epidemiology"}],"tags":[],"updatedAt":"2025-07-16T12:08:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-16 12:08:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6276723","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6276723","identity":"rs-6276723","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}