Research Article: Clinical and economic impacts of a clinical pathway-based single disease payment policy on hysterectomy for uterine fibroids: a decade-long interrupted time series analysis

Abstract:
In 2017, China introduced clinical pathway-based single disease payment (CP-SDP) to curb healthcare costs, yet its impact is uncertain. Using uterine fibroids as a case, we evaluated its effectiveness. We analyzed 4,727 hysterectomy cases for uterine fibroids from a tertiary hospital in Fujian Province between January 2014 and December 2023. Using an interrupted time series (ITS) with August 2017 as the intervention point, we fitted a segmented regression model to estimate immediate level changes and post-intervention trends. The impact of CP-SDP was evaluated across structure, process, and clinical outcome domains. The utilization of laparoscopic surgery significantly increased from 45.1 to 75.5%, accompanied by 3.51?days reduction in average hospital stay. Significant changes had occurred in the cost structure: technical service fees (e.g., pathological diagnostics [+32.4%] and imaging [+7.3%]) increased, whereas consumable costs (e.g., antibacterial drugs [?48.5%] and disposable supplies [?19.5%]) decreased significantly. Hospitalization expenses decreased by 2.7%, while the postoperative complication rate decreased from 7.8 to 4.9%. ITS analysis showed that after the policy, hospitalization expenses immediately decreased by 2265.51 ¥ (13.28%) and continued to decrease. The long-term trend of out of pocket expenses had shifted from increasing to decreasing, and the proportion of medical insurance reimbursement had shifted from decreasing to increasing. In 2023, out-of-pocket expenses had reached their lowest level, whereas the reimbursement ratio had peaked. CP-SDP appears to control costs while improving care quality by promoting minimally invasive procedures and optimizing cost allocation. This approach substantially reduces patients’ long-term financial burden.

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