DRG payment for male reproductive system malignant tumor surgery: analysis and recommendations on resource consumption in a tertiary hospital in China.

Abstract

Aim: This study aimed to examine the consistency of resource consumption (cost homogeneity) and influencing factors of the diagnosis-related group (DRG) "major operations for malignant tumors of the male reproductive system with general complications or comorbidities" (MA13) and offer recommendations for improving the efficacy of the grouping.

Methods: This retrospective study analyzed medical records and insurance settlement data of all MA13 patients admitted to a tertiary urology department from January 2021 to December 2024. Combined with semi-structured interviews with urologists, key clinical cost drivers were identified. Multiple linear regression analysis was utilized to assess the significance of these factors and their specific impact on various service costs. We provided recommendations for improving MA13 groupings and evaluated their effectiveness using the coefficient of variation (CV) and t-tests.

Results: The CV for the MA13 group was 0.41. Age and robot-assisted surgery emerged as independent factors due to their statistically dominant effects (P < 0.001) in multivariate regression, whereas comorbidities and insurance type showed limited explanatory power (adjusted R² = 0.72). Subgrouping MA13 by age and robotics reduced intra-group heterogeneity (CV: 0.12-0.35 vs. 0.41), enabling equitable reimbursement for advanced surgical techniques while maintaining manageable DRG categories.

Conclusions: Supplementary payments for robot-assisted surgery should be considered to ensure equitable access to advanced technologies while maintaining cost-effectiveness. Stratified validation methods are essential for evaluating grouping effectiveness, which can help improve intra-group consistency and facilitate a more equitable distribution of medical resources.