The impact of global budget on expenditure, service volume, and quality of care among patients with pneumonia in a secondary hospital in China: a retrospective study

Impacts of case-based payments reform on healthcare providers' behaviour on cataract surgery in a tertiary hospital in China: An eight-year retrospective study

BACKGROUND

Case-based payment has extensively been adopted to replace the fee-for-service payment in China. This paper aims to assess the impacts of case-based payment reform on the providers' behaviour using cataract surgery as an example.

METHODS

A total of 400 cataract inpatients were sampled in a tertiary hospital. Data analysis consisted of descriptive statistics, Wilcoxon rank-sum test and Chi-square test.

RESULTS

The number of routine preoperative laboratory tests and drugs significantly declined after the case-based payment reform (p < 0.001). Healthcare providers significantly reduced the use frequency of systemic glucocorticoids (GCs) and antibiotics, adjuvant drugs, multiple antibiotic eye drops, generic drugs in cataract surgery after reform (p < 0.001), and they reduced non-ophthalmic medications after reform (p < 0.01). Notably, all patients were prescribed GC eye drops, antibiotic eye drops, and original drugs in both groups. Moreover, the preoperative, postoperative, and total length of stay (LOS) declined after the reform (p < 0.001). Nonetheless, no significant difference was noted in the care quality between the two group.

CONCLUSION

The case-based payment reform decreased the intensity of care by reducing unnecessary drugs and retaining necessary drugs on cataract surgery. Besides, the LOS was shortened. Further, an impaired care quality was not witnessed, however, cost-shifting warrants further attention.