How significant is cost-shifting behavior under the diagnosis intervention packet payment reform? Evidence from the coronary heart disease market

BackgroundControlling the growth of inpatient costs presents a major challenge in China’s healthcare system. China introduced a new case-based payment method, the “Diagnosis Intervention Packet” (DIP), to address the surge in hospitalization expenses. However, the influence of DIP payment reform on cost shifting among coronary heart disease (CHD) inpatients remains unclear.MethodsThis study focused on Zunyi, a national pilot city for DIP, utilizing inpatient claim data to assess the effects of DIP payment reform. We analyzed the influence on total health expenditures (THE), individual payments excluding reimbursement (IPER), proportion of IPER, copayments for category-B, proportion of copayments for category-B, copayments for category C, and proportion of copayments for category C per case for CHD inpatient.ResultsResults indicate a significant reduction in THE per case for CHD inpatients after the DIP reform (β = −0.1272, p