Table 5.
Relationship Between Hospitals’ Policy and Physicians’ Behavior
| Hospitals’ Policy | Physicians’ Behavior | Non-Implementation (Mean±SD) | Implementation (Trend) (Mean±SD) | P value |
|---|---|---|---|---|
| Strengthen the quality management of the first page on medical record | Reduce the examination after admission | 3.52±1.10 | 3.90±0.88 (↑) | 0.044 |
| Reduce the time of medications prescribed | 3.56±0.92 | 4.00±0.92 (↑) | 0.012 | |
| Replace higher-priced originals with lower-priced generics | 3.19±1.24 | 3.65±1.07 (↑) | 0.039 | |
| Increase patient referrals | 3.52±1.00 | 3.10±1.00 (↓) | 0.027 | |
| Promote clinical pathway implementation | More pre-admission examinations | 4.39±0.92 | 3.94±0.93 (↓) | 0.014 |
| Reduce the examination after admission | 3.43±1.13 | 3.91±0.86 (↑) | 0.018 | |
| Reduce the time of medications prescribed | 3.57±0.87 | 3.94±0.96 (↑) | 0.038 | |
| Reduce the use of adjuvant medications | 3.68±0.98 | 4.04±0.89 (↑) | 0.045 | |
| Reduce the use of prophylactic antibiotics | 3.75±1.04 | 4.16±0.74 (↑) | 0.026 | |
| Replace higher-priced originals with lower-priced generics | 3.02±1.27 | 3.70±1.03 (↑) | 0.004 | |
| Case split | 3.68±1.14 | 3.27±0.99 (↓) | 0.044 | |
| Enhance cost accounting management | Reduce the time of medications prescribed | 3.54±0.90 | 3.98±0.94 (↑) | 0.013 |
| Increase performance of day surgery | 3.71±0.87 | 4.11±0.81 (↑) | 0.014 | |
| Transform hospital information system for DRG | Reduce the number of medications prescribed | 3.55±1.02 | 4.03±0.84 (↑) | 0.012 |
| Reduce the time of medications prescribed | 3.55±0.83 | 3.94±0.98 (↑) | 0.029 | |
| Carry out the publicity and training of DRG-related knowledge | Reduce the number of medications prescribed | 3.65±0.89 | 4.02±0.94 (↑) | 0.035 |
| Reduce the use of prophylactic antibiotics | 3.80±0.85 | 4.16±0.88 (↑) | 0.032 | |
| Cost-shifting to outpatient | 3.41±1.04 | 2.95±1.10 (↓) | 0.025 | |
| Refuse to admit critically ill patients | 3.20±1.20 | 2.52±1.28 (↓) | 0.005 | |
| Increase patient referrals | 3.53±0.73 | 3.10±1.17 (↓) | 0.017 | |
| Include DRG relevant indicators in the performance appraisal system of a department or physician | Strict control of the surgical indication | 4.07±0.80 | 4.38±0.74 (↑) | 0.047 |
| Reduce the time of medications prescribed | 3.40±0.98 | 4.01±0.85 (↑) | 0.001 | |
| Accept more patients without medical insurance or non-local | 3.58±1.04 | 3.22±0.85 (↓) | 0.049 | |
| Select the more profitable cases | 3.70±0.94 | 3.26±1.11 (↓) | 0.034 | |
| Summarize the operation of DRG and give regular feedback to the department or physician | More compliance with clinical pathway | 3.90±0.50 | 4.18±0.45 (↑) | 0.003 |
| Increase the use of essential medications | 3.70±0.97 | 4.05±0.86 (↑) | 0.047 | |
| Limit the usage of expensive medications or consumables | Shorten the length of stay | 3.52±1.03 | 3.95±0.72 (↑) | 0.011 |
| Reduce the time of medications prescribed | 3.55±0.94 | 4.05±0.88 (↑) | 0.004 | |
| Reduce the use of adjuvant medications | 3.69±1.06 | 4.13±0.74 (↑) | 0.012 | |
| Increase volumes of admissions | 3.34±1.02 | 2.89±1.30 (↓) | 0.042 | |
| Case split | 3.71±1.06 | 3.14±1.00 (↓) | 0.004 | |
| Limit the proportional cost of total medical expenses (eg the proportion of medication or consumable costs) | More pre-admission examinations | 4.31±0.75 | 3.93±1.07 (↓) | 0.031 |
| Reduce the number of medications prescribed | 3.65±0.94 | 4.03±0.90 (↑) | 0.027 | |
| Replace higher-priced originals with lower-priced generics | 3.17±1.16 | 3.68±1.13 (↑) | 0.018 | |
| Reduce the use of expensive consumables | 3.85±1.04 | 4.23±0.81 (↑) | 0.030 | |
| Accept more patients without medical insurance or non-local | 3.56±0.86 | 3.15±0.95 (↓) | 0.019 | |
| Case split | 3.74±0.89 | 3.15±1.13 (↓) | 0.003 | |
| Limit hospitalization costs | Replace higher-priced originals with lower-priced generics | 3.29±1.15 | 3.89±1.13 (↑) | 0.017 |
| Refuse to admit critically ill patients | 2.64±1.19 | 3.39±1.42 (↑) | 0.015 | |
| Deny care to cases with over the ceiling prices | 2.53±1.32 | 3.32±1.42 (↑) | 0.008 | |
| Limit the length of stay | More pre-admission examinations | 3.58±1.10 | 4.26±0.86 (↑) | 0.002 |
| Replace higher-priced originals with lower-priced generics | 3.30±1.14 | 3.96±1.16 (↑) | 0.013 | |
| Deny care to cases with over the ceiling prices | 2.59±1.34 | 3.25±1.42 (↑) | 0.036 |
Notes: ↑Meaning the score increased in the hospitals where the policy was implemented compared with those not implemented; ↓Meaning the score decreased in the hospitals where the policy was implemented compared with those not implemented.