Physician Preferences and Decision-Making Differences Under China’s DIP Payment Refo rm: A Discrete Choice Experiment

Background: Understanding how payment reforms shape clinical decision-making is central to advancing value-based healthcare. In China, the Diagnosis-Intervention Packet (DIP) model has been introduced to balance cost control with quality assurance; however, little is known about how its combined financial and regulatory incentives influence physicians'admission decisions at the micro level, or how preferences and behavioral responses differ across physician subgroups. Methods: A discrete choice experiment was administered to 339 clinical physicians in a central Chinese tertiary hospital following DIP implementation. The experiment included attributes covering key clinical, financial, and regulatory factors. Physician preferences were estimated using a mixed logit model, and a latent class model identified heterogeneous decision-making types. Results: Results indicated that financial incentives were the primary driver of admission decisions, characterized by a marked loss-aversion pattern; the motivation to avoid financial losses was roughly four times stronger than the pursuit of gains. Compliance risk was the third most significant factor. The analysis further identified five latent physician groups with systematically distinct preferences: risk-averse (21.7%), technology-preferring (16.4%), high-risk-high-reward (20.6%), economically-driven (28.5%), and conservatively compliant (12.8%). Each group employed a significantly different logic in trading off clinical, economic, and regulatory attributes. Conclusions: The DIP reform has reconfigured physicians' behavioral responses around financial and compliance incentives, while revealing substantial preference heterogeneity. A uniform payment policy may induce risk selection or clinical distortion. Moving forward, policy optimization must recognize these varied motivational profiles and integrate blended payments, targeted supervision, and enhanced hospital governance to sustain a balance between cost containment and care quality.