Physician admission preferences under the Diagnosis-Intervention Packet payment system: a discrete choice experiment in a Chinese tertiary hospital
- 1First Affiliated Hospital, Henan Medical University
- 2Faculty of Education, Henan Normal University
- 3School of Medical Humanities, Henan Medical University
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: Expected DIP loss was strongly negatively associated with admission preference ( β = −1.81, p < 0.001), whereas expected profit was associated with a smaller positive preference ( β = 0.45, p < 0.001). A Wald test confirmed a significantly stronger response to losses than gains ( p < 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.
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BibTeX
@article{song2026physician,
title = {{Physician admission preferences under the Diagnosis-Intervention Packet payment system: a discrete choice experiment in a Chinese tertiary hospital}},
author = {Yuanming Song and Siyue Zheng and Mingkai Zhao and Zunzun Nie and Shuaihe Zhu and Kang Li and Xuefeng Duan and Yuxue Feng},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1946819},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1946819/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Physician admission preferences under the Diagnosis-Intervention Packet payment system: a discrete choice experiment in a Chinese tertiary hospital
AU - Yuanming Song
AU - Siyue Zheng
AU - Mingkai Zhao
AU - Zunzun Nie
AU - Shuaihe Zhu
AU - Kang Li
AU - Xuefeng Duan
AU - Yuxue Feng
PY - 2026
DA - 2026/10/22
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1946819
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1946819/full
AB - 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: Expected DIP loss was strongly negatively associated with admission preference ( β = −1.81, p < 0.001), whereas expected profit was associated with a smaller positive preference ( β = 0.45, p < 0.001). A Wald test confirmed a significantly stronger response to losses than gains ( p < 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.
SN - 2296-2565
ER -