Construction of a Closed-Loop Management System for Hospital Operations Driven by the Diagnosis-Related Groups (DRG) System for Medical Insurance: Promoting High-Quality Development of Hospitals

Abstract

Objective: Taking the reform of the Diagnosis-Related Groups (DRG) payment system for medical insurance as an opportunity, we aim to construct a closed-loop management system for lean hospital operations under the trusteeship of urban medical groups, thereby promoting high-quality hospital development. Methods: Led by the Medical Insurance DRG Management Committee, we established a closed-loop MDT-DRG management system, data analysis system, pharmaceutical and consumable management system, discipline construction management system, and standardized medical record front page filling management system. These measures enabled refined operational management, fostering high-quality hospital development. Results: After the trusteeship of Qingdao Municipal Hospital from 2024 to 2025, leveraging the reform of the medical insurance DRG payment system, combined with the integration of medical disciplines and improved performance management, lean operational management effectively achieved six improvements (15.25% year-on-year increase in outpatient and emergency visits, 7.62% increase in discharges, 50.08% increase in surgeries, 71.89% increase in Level IV surgeries, 10.76% increase in Case Mix Index, and 45.99% increase in cases with weights > 2), two reductions (41.18% decrease in average inpatient drug costs and 28.69% decrease in average outpatient drug costs), and one innovation (78.92% year-on-year increase in Level IV surgeries for national examinations). Conclusion: This effectively promoted the overall operational efficiency and competitiveness of the hospital, laying a solid foundation for the establishment of a tertiary hospital and achieving the goal of satisfaction for the government, hospital, medical insurance, and patients.