Associations of Chinese diagnosis-related group system with low-value coronary revascularisation: an interrupted time series analysis

OBJECTIVES: This study aimed to investigate whether the Chinese diagnosis-related group (C-DRG) payment system would reduce low-value coronary revascularisation services among coronary heart disease (CHD) inpatients without affecting high-value coronary revascularisation services. DESIGN: Retrospective observational study. SETTING: Routinely collected claims data from a health insurance database including all inpatients in 22 public hospitals in Sanming, Southern China. PARTICIPANTS: All patients with CHD are admitted to public hospitals from 1 January 2017 through 31 December 2020. INTERVENTION/EXPOSURE: The implementation of the C-DRG-based payment system on 1 January 2018. MAIN OUTCOME MEASURES: Using a health insurance database, we identified two cohorts: beneficiaries for whom the value of coronary revascularisation is lower (those with ischaemic heart disease without acute myocardial infarction, unstable angina and congestive heart failure during hospitalisation) and beneficiaries for whom its value is higher (those with acute coronary syndrome). Then, the rates of low-value or high-value coronary revascularisation were compared before and after the implementation of C-DRG policy, including the use of an interrupted time series analysis. RESULTS: An interrupted time series analysis demonstrated that the C-DRG policy was associated with a statistically significant immediate decrease in the rate of low-value coronary revascularisation of -9.78% (95% CI: -11.08% to -8.48%). Further, after introducing C-DRG, the rate of low-value coronary revascularisation decreased by -0.59% (95% CI: -0.88% to -0.30%) every quarter compared with before C-DRG. In addition, after C-DRG, the rate of high-value coronary revascularisation increased by 1.27% (95% CI: 0.14% to 2.41%) every quarter compared with before C-DRG. CONCLUSIONS: This study suggested that C-DRG policy achieved at least short-term success in reducing use of low-value coronary revascularisation without evidence of decreasing high-value coronary revascularisation services. These results can support policymakers in reducing low-value care in China and other countries that use similar systems.