The effects of diagnosis-intervention packet payment on healthcare in Chinese public hospitals: a systematic review and meta-analysis

To control the rapid growth of health expenditures, China developed an innovative case-based payment system for inpatient care called the diagnosis-intervention packet (DIP) payment. However, the effectiveness of DIP payment in public hospitals is mixed. This study aims to conduct a systematic review and meta-analysis to investigate the effects of DIP-based payment on healthcare in terms of quantity, efficiency, quality, and expenditure of public hospitals in China. We searched PubMed, Embase, the Cochrane Library, Web of Science, EBSCO, ProQuest, Opengrey, the China National Knowledge Infrastructure, Wanfang, cqvip, and China Biology Medicine disc from October 2003 to December 2023. Twenty studies were identified and examined, including six non-randomized controlled trials, ten controlled before-after studies, and four interrupted time series studies. The meta-analysis revealed that DIP payment was effective in improving efficiency by shortening the length of stay. There was no significant overall effect on the quantity of healthcare. Based on the results of in-hospital mortality and readmission within 30 days, quality was partially improved. The meta-analysis did not show a significant decrease in total expenditures per case, but there were some positive changes in the structure of hospitalization expenditures. There is insufficient evidence to establish a definitive relationship between DIP-based payment and healthcare in Chinese public hospitals. Future research should explore the long-term effects of the DIP payment reform. Before applying and implementing the DIP-based payment, policymakers need to consider its positive and negative outcomes. This can help policymakers make better decisions on provider payment reform to improve hospital healthcare.