Table 3.

Summary of effects of diagnosis-related groups payment on healthcare in studies from mainland China

Location/Study	Study design	Expenditure per admission	Out of pocket payment	Length of stay	Quality of care	Equity of care	Up coding	Quality rating (NOS)*
Shanghai/Zhang 2010 [13]	CBA	↔		↔		↓		8
Beijing/Jian 2015b [11]	CBA	↓	↓	↔	↓	↓		9
Beijing/Zhang 2015 [43]	CBA	↑	↓	↓	↑	↓		7
Changsha, Hunan province/Zhang 2016 [14]	CBA	↓		↓	↑			8
Beijing /Poon 2017 [12]	CBA	↓			↓↑	↓		9
Beijing /Ji 2017 [45]	CBA	↓	↔	↓				7
Harbin, Heilongjiang province/Wang 2015 [39]	ITS	↑	↔	↔			↑	5
Guangxi province/Wu 2015a [41]	ITS	↑	↑	↔				6
Tianjin/Li 2012 [31]	BA	↓		↓	↑			8
Lufeng, Yunnan province/Peng 2016 [44]	BA	↑		↓			↑	6
Xiangyun, Yunnan province/Peng 2017 [46]	BA	↓		↓				7
Yuxi, Yunnan province/Yan 2017 [47]	BA	↓		↓				7
Yuxi, Yunnan province/Zhou 2018 [48]	BA	↓						6
Number of studies		13 (6 CBA, 2ITS, 5 BA)	5 (3 CBA, 2 ITS)	11 (5 CBA, 2 ITS, 4 BA)	5 (4 CBA, 1 BA)	4 CBA	1 ITS, 1 BA
Summary of effect		Mixed	Mixed	Mild decrease	Mixed	Decrease	Increase
Certainty of the evidence (GRADE)		Very low1	Very low1	Low2	Very low1	Moderate3	Low2

High certainty: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low

Moderate certainty: This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different† is moderate

Low certainty: This research provides some indication of the likely effect. However, the likelihood that it will be substantially different† is high

Very low certainty: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high

^1.The evidence was by default graded as low as all studies were classified as non-randomised and observational studies, and further downgraded to very low due to the high risk of bias and inconsistency across findings

^2.The evidence was by default graded as low as all studies were classified as non-randomised or observational studies

^3.The evidence was by default graded as low as all studies were classified as non-randomised studies, but upgraded to moderate for consistency across findings

CBA: controlled before after study, ITS: interrupted time series study, BA: uncontrolled before-after study, *Number of items with low risk of bias in 9 total items of quality assessment using a modified Newcastle-Ottawa scale (NOS), Direction of change: ↑up, ↓down, ↔ even