International Journal of Health Policy and Management

International Journal of Health Policy and Management

Association Between China’s DRG Reform and Value-Based Healthcare Orientation: Evidence From Inpatients With Acute Myocardial Infarction and Cancer in Tertiary Hospitals in Western China

Document Type : Original Article

Authors
Haoran Li 1, 2
Fukun Zhu 1
Tao Xie 3
Ning Zhang 4
Austen El-Osta 2
Zhonghan Wang 1
Ying Mao 1
1 School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
2 School of Public Health, Imperial College London, London, UK
3 School of Political Science and Public Administration, Wuhan University, Wuhan, China
4 Vanke School of Public Health, Tsinghua University, Beijing, China
10.34172/ijhpm.9669
Abstract
Background
Implementing diagnosis-related groups (DRGs) reform under the guidance of value-based healthcare (VBH) is of great significance for China to curb the rapid rise of medical costs and promote the allocation and utilization of medical resources. However, current research evaluating the effectiveness of China’s DRGs reform lacks a valuebased oriented approach to healthcare and has not yet explored whether different types of diseases and population characteristics will affect policy implementation.

Methods
A total of 16 564 acute myocardial infarction (AMI) and 74 356 cancer inpatients were included in this singlecenter study during 2018-2022. Interrupted time series models were used to estimate post-reform level and slope changes. Exploratory subgroup analyses were conducted by gender, age, and disease type. Hospital-level outcomes included riskadjusted success per cost (SPC), cost per success (CPS), and net monetary benefit (NMB). Individual-level outcomes included total hospitalization cost, length of stay, mortality, successful outcomes, and 30-day readmission.

Results
DRG reform was associated with changes in VBH indicators, with AMI mainly showing slope changes and cancer mainly showing level changes. However, individual-level analyses showed that some clinical outcomes did not improve consistently, which differed from the hospital-level results.

Conclusion
The findings suggest that DRG reform was associated with changes in selected hospital-level VBH indicators, while some individual-level clinical outcomes did not show consistent improvement. Future payment reform should combine disease-specific clinical pathways, stronger risk adjustment, and routine monitoring of patient-level quality outcomes, especially for acute and high-risk conditions.
Keywords
Value-Based Healthcare
Diagnosis-Related Groups
Interrupted Time Series
Acute Myocardial Infarction
Cancer
Western China
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International Journal of Health Policy and Management
Volume 15, Issue 1
2026
Pages 1-13

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  • Received Date 09 December 2025
  • Revised Date 06 June 2026
  • Accepted Date 12 July 2026
  • First Published Date 14 July 2026
  • Published Date 01 December 2026