The Widening Gap: How Differential Payment Standards Under Diagnosis-Intervention Packet Reform Influence Patients with Different Types of Medical Insurance
1
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Popul. Med. 2026;8(Supplement Supplement 1):A1205
ABSTRACT
BACKGROUND:
This study investigates the progressive impact of the Diagnosis-Intervention Packet (DIP) payment reform featuring annually widening, differential payment standards for Urban Employee Basic Medical Insurance (UEBMI) and Urban-Rural Resident Medical Insurance (URRBMI) on healthcare equity. We analyze how this dual-track policy design dynamically influences medical costs, patients' economic burden, patient selection, and quality of care, focusing on diseases with varying clinical discretion and across different hospital levels.
METHODS:
We analyzed over 3.6 million inpatient records from City A (treatment site with widening payment gaps) and City B (control site with unified standards). Using interrupted time-series analysis, we compared monthly ratios (UEBMI/URRBMI) for hospitalization costs, out-of-pocket payments, Elixhauser Comorbidity Index (ECI), and 31-day readmissions. Two representative conditions were selected: ischemic stroke (low clinical discretion) and atherosclerotic heart disease (high clinical discretion).
RESULTS:
In City A, the widening gap significantly compromised equity for atherosclerotic heart disease. Following the first intervention, the cost ratio trend increased by 0.03% (p<0.01), accelerating by an additional 0.04% monthly (p<0.01) after the third intervention, indicating a cumulative policy effect. Significant trend increases in ECI and 31-day readmission ratios were also observed, suggesting provider-induced patient selection and quality erosion. Conversely, impacts on ischemic stroke were minimal. Notably, tertiary hospitals primarily adjusted the ECI ratio, while non-tertiary hospitals exhibited widespread, complex disparity increases across all metrics. City B showed no significant changes under its unified standard.
CONCLUSIONS:
Our findings demonstrate that widening insurance payment gaps create escalating risks to health equity, particularly for high-discretion conditions and in non-tertiary healthcare settings. This provides critical evidence for the need for targeted regulatory monitoring and the rational calibration of payment standards to achieve Universal Health Coverage goals in countries with fragmented health financing systems.
This study investigates the progressive impact of the Diagnosis-Intervention Packet (DIP) payment reform featuring annually widening, differential payment standards for Urban Employee Basic Medical Insurance (UEBMI) and Urban-Rural Resident Medical Insurance (URRBMI) on healthcare equity. We analyze how this dual-track policy design dynamically influences medical costs, patients' economic burden, patient selection, and quality of care, focusing on diseases with varying clinical discretion and across different hospital levels.
METHODS:
We analyzed over 3.6 million inpatient records from City A (treatment site with widening payment gaps) and City B (control site with unified standards). Using interrupted time-series analysis, we compared monthly ratios (UEBMI/URRBMI) for hospitalization costs, out-of-pocket payments, Elixhauser Comorbidity Index (ECI), and 31-day readmissions. Two representative conditions were selected: ischemic stroke (low clinical discretion) and atherosclerotic heart disease (high clinical discretion).
RESULTS:
In City A, the widening gap significantly compromised equity for atherosclerotic heart disease. Following the first intervention, the cost ratio trend increased by 0.03% (p<0.01), accelerating by an additional 0.04% monthly (p<0.01) after the third intervention, indicating a cumulative policy effect. Significant trend increases in ECI and 31-day readmission ratios were also observed, suggesting provider-induced patient selection and quality erosion. Conversely, impacts on ischemic stroke were minimal. Notably, tertiary hospitals primarily adjusted the ECI ratio, while non-tertiary hospitals exhibited widespread, complex disparity increases across all metrics. City B showed no significant changes under its unified standard.
CONCLUSIONS:
Our findings demonstrate that widening insurance payment gaps create escalating risks to health equity, particularly for high-discretion conditions and in non-tertiary healthcare settings. This provides critical evidence for the need for targeted regulatory monitoring and the rational calibration of payment standards to achieve Universal Health Coverage goals in countries with fragmented health financing systems.
| eISSN: | 2654-1459 |
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