Impact of diagnosis-related group systems on inpatient expenditures and medical quality for children with leukemia: evidence from real-world data.

[BACKGROUND] In 2021, nationwide Diagnosis-Related Groups (DRG) reform was initiated and the DRG-based medical insurance payment method has been widely applied in China. However, few studies focused on pediatric leukemia patients where the inherent tension between cost control and nursing quality is particularly pronounced and systematically explored whether DRG has controlled unnecessary expenditures, optimized cost structures, while maintaining the quality, which warrants urgent evaluation.

[METHOD] This study analyzed hospitalization data for pediatric leukemia patients treated at the Children’s Specialized Hospital in City U between October 2022 and July 2024. Patients were categorized into two groups based on whether their hospitalizations were settled using the DRG payment system. Quantile regression, beta regression with a logit link function, and logistic regression were employed to evaluate the effect of DRG reform on hospitalization costs, the proportion of medical expenses, 30-day readmission rates and improvement, respectively. Propensity Score Matching is used to balance the characteristic differences between samples in DRG group and the Non-DRG group.

[RESULT] Both before and after matching, patients under the DRG payment model consistently exhibited a significantly lower proportion of medication expenses (OR = 0.774–0.806), a higher proportion of diagnostic testing expenses (OR = 1.135–1.157) and a higher proportion of consumables expenses (OR = 1.127–1.151 ) compared to those under the non-DRG model. No significant effects were observed on outcomes variables of hospitalization expense and medical quality.

[CONCLUSION] As an early situational evaluation, this study indicates that while DRG reform has not yet reduced total expenditures for pediatric leukemia due to rigid treatment protocols, it has significantly altered the cost structure by shifting resource allocation from medications to diagnostics and consumables. This transformation reflects an initial optimization of cost structure but also highlights the need to monitor the rationality of diagnostic expenditures to prevent compensatory cost-shifting. Furthermore, no effect on proportion of treatment expenses suggests that the valuation of medical staff labor requires further improvement. DRG reform is limited in its ability to reduce overall expenditures, efforts should continue to control medical costs by optimizing DRG payment methods, enhancing medical security for children with leukemia, and strengthening expense monitoring.

[SUPPLEMENTARY INFORMATION] The online version contains supplementary material available at 10.1186/s12913-025-13978-x.