A Study on the Relationship among Weight,Cost Multiplier,and Patient Out-of-Pocket Expenses under the DRG Pay-ment System

Ding Jingmei; Hu Xuejun; Cai Jie

Abstract：Objective:The interrelationship among weight,magnification,and patients'Out-of-Pocket(OOP)within the DRG payment system were analyzed to provide empirical evidence for optimizing the DRG payment policy and reasonably controlling patients'medical burden.Methods:The data of 46 342 patients who were successfully enrolled and paid through DRG in a tertiary hospital of Wuhan from 2023 to 2024 were utilized.After conducting a correlation analysis,a moderation effect model,a grouped linear regression model,and a quantile regression model were constructed to explore the relationships among these three elements.Results:Partial correlation analysis after controlling for confounding factors showed that the three elements were significantly correlated.The multiple played a significant positive moderating role in the relationship between weight and OOP.As the multiple increased,the positive impact of weight on OOP grew explosively.The size of the quantile regression coefficient showed a significant increasing trend as the quantile increased.The impact of weight on OOP was the strongest at the 90%quantile point of OOP(P＜0.01).Conclusion:In DRG payment,there is a close relationship among weights,case multipliers,and OOP.Weights establish the cost benchmark,while case multipliers cause the actual costs to fluctuate above and below this benchmark,and the combined effect of these two factors ultimately determines the level of the patient's economic burden.