Analysis on the Characteristics of Low-Rate Cases and Hospital Management Strategies under DIP Policy/

Chen Di; Su Jinghan; Lü Xiangwei

Abstract：Objective:To investigate the clinical characteristics,contributing factors,and impacts of low-ratio cases under the Diagnosis-Intervention Packet(DIP)in tertiary hospitals,and propose actionable management strategies to promote the compliance and efficiency of medical insurance payment in tertiary hospitals.Methods:Based on retrospective analysis of 98 298 DIP-settled cases(January-October 2024)from a tertiary hospital in Henan,18 126 low-ratio and 80 172 normal-ratio cases were selected.Comparative metrics(demographics,hospitalization duration,primary care-sensitive conditions,medical insurance reimbursement ratios)were analyzed using non-parametric tests.Pareto analysis was applied to identify key diagnostic clusters.Results:Low-ratio cases exhibited distinct features:38.6％patients aged ≥61 years,32.5％hospital stays＜48 hours,l.0％primary care-sensitive conditions,Median reimbursement ratio was 0.69,with significant differences compared with general group.Seven diagnostic clusters(myeloproliferative disorders,poorly differentiated tumors,impact factors for health,medical treatment situation,etc.)accounted for 75.36％of low-ratio cases.Conclusion:It is suggested to optimize the medical service management under DIP payment through standardizing clinical pathways,enhanced coding quality,establishing policy feedback mechanisms,and promoting data governance.