Impact of Risk Adjustment for Drug-Resistant Types on Tuberculosis Patients’ Outcomes under China’s Innovative Diagnosis-Intervention Packet Payment Methods
1
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, Wuhan, China
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Treating drug-resistant tuberculosis (DR-TB) is clinically complex and imposes a significantly higher economic burden than drug-susceptible tuberculosis (DS-TB). China’s Diagnosis-Intervention Packet (DIP) payment system initially lacked risk adjustment for drug resistance. In 2022, a pilot city implemented adjusted reimbursement standards to differentiate between these types. This study evaluates the impact of this risk adjustment on medical expenditures, treatment efficiency, and care quality.
METHODS:
We employed a quasi-experimental difference-in-differences design analyzing 8,465 tuberculosis patients from June 2021 to December 2023 across two pilot cities. Outcomes included inpatient and out-of-pocket (OOP) expenditures, length of stay (LOS), and 30-day unplanned readmission rates. Subgroup analyses were conducted for both drug-resistant and drug-susceptible patients.
RESULTS:
For all tuberculosis patients, the risk adjustment led to significant reductions in inpatient out-of-pocket expenditure per hospitalization ($257.51, p < 0.001) and inpatient length of stay (3.58 days, p < 0.001). In the drug-susceptible subgroup, the policy significantly reduced annual total inpatient expenditure (0.75, p = 0.028) and total annual out-of-pocket costs (0.01, p < 0.001). Crucially, for drug-resistant patients, the policy maintained stability in expenditures, efficiency, and care quality (all p > 0.05), indicating that providers received adequate compensation without increasing the patient's burden. No significant adverse impact on the 30-day readmission rate was observed across groups.
CONCLUSIONS:
The risk adjustment policy under the Diagnosis-Intervention Packet system effectively optimized resource allocation and enhanced efficiency, particularly for drug-susceptible patients, while safeguarding care quality for the high-cost drug-resistant population. These findings provide vital evidence for implementing tailored risk adjustment within payment frameworks to manage heterogeneous infectious diseases and achieve sustainable health financing.
Treating drug-resistant tuberculosis (DR-TB) is clinically complex and imposes a significantly higher economic burden than drug-susceptible tuberculosis (DS-TB). China’s Diagnosis-Intervention Packet (DIP) payment system initially lacked risk adjustment for drug resistance. In 2022, a pilot city implemented adjusted reimbursement standards to differentiate between these types. This study evaluates the impact of this risk adjustment on medical expenditures, treatment efficiency, and care quality.
METHODS:
We employed a quasi-experimental difference-in-differences design analyzing 8,465 tuberculosis patients from June 2021 to December 2023 across two pilot cities. Outcomes included inpatient and out-of-pocket (OOP) expenditures, length of stay (LOS), and 30-day unplanned readmission rates. Subgroup analyses were conducted for both drug-resistant and drug-susceptible patients.
RESULTS:
For all tuberculosis patients, the risk adjustment led to significant reductions in inpatient out-of-pocket expenditure per hospitalization ($257.51, p < 0.001) and inpatient length of stay (3.58 days, p < 0.001). In the drug-susceptible subgroup, the policy significantly reduced annual total inpatient expenditure (0.75, p = 0.028) and total annual out-of-pocket costs (0.01, p < 0.001). Crucially, for drug-resistant patients, the policy maintained stability in expenditures, efficiency, and care quality (all p > 0.05), indicating that providers received adequate compensation without increasing the patient's burden. No significant adverse impact on the 30-day readmission rate was observed across groups.
CONCLUSIONS:
The risk adjustment policy under the Diagnosis-Intervention Packet system effectively optimized resource allocation and enhanced efficiency, particularly for drug-susceptible patients, while safeguarding care quality for the high-cost drug-resistant population. These findings provide vital evidence for implementing tailored risk adjustment within payment frameworks to manage heterogeneous infectious diseases and achieve sustainable health financing.
| eISSN: | 2654-1459 |
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