Work

Physician admission preferences under the Diagnosis-Intervention Packet payment system: a discrete choice experiment in a Chinese tertiary hospital

Year: 2026

Type: article

Abstract: Background: Payment reforms seek to contain costs while maintaining quality, but their effects depend on how frontline physicians respond to financial and regulatory signals. China's Diagnosis-Intervention Packet (DIP) reform is a case-based, point-based payment model implemented within a regional global budget. Objective: To examine physicians' admission preferences and trade-offs across clinical, financial, operational, and regulatory attributes within a tertiary hospital operating under the DIP payment system. Methods: We conducted a cross-sectional discrete choice experiment among 339 physicians in a tertiary hospital in central China. Six attributes captured clinical complexity, length of stay, treatment technology, service revenue, expected DIP margin, and compliance risk. Physicians' choice preferences and opt-out choices were analyzed using mixed logit models, and preference heterogeneity was further examined using latent class logit models. Results: < 0.001), consistent with loss aversion. Expected DIP margin accounted for 41.94% of relative attribute importance, followed by clinical complexity (20.11%) and compliance risk (16.01%). Opt-out analysis showed that expected loss, higher clinical complexity, above-benchmark length of stay, and compliance risk were associated with a greater tendency to select the opt-out option. Five distinct preference profiles were identified. Conclusion: Physician admission preferences under DIP were associated with financial, clinical, operational, and regulatory factors, with substantial heterogeneity across physicians. These findings may inform coordinated refinements in payment design, regulatory oversight, and hospital management.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1946819