Research on the influence mechanism of medical insurance pressure on performance appraisal of public hospitals under the background of diagnosis related groups payment implementation

International Journal of Research Studies in Management
Divine Word College of San Jose Special Issue
2026 Volume 14 Issue 4

Available Online: 30 June 2026

Author/s:

Zuo, Xinyang
Zuo, Yuyang
Wang, Hao
Nurmagambetova, Azhar*
Al-Farabi International Business School, Al-Farabi Kazakh National University, Kazakhstan

Abstract:

The increasing pressure on medical insurance funds in China has necessitated reforms in healthcare financing and hospital management. The Diagnosis Related Groups payment model, as a refined medical insurance payment mechanism, has been widely adopted in public hospitals. This study investigates the influence mechanism of medical insurance pressure on the performance appraisal of public hospitals under the context of Diagnosis Related Groups payment implementation. Through a comprehensive analysis of the conceptual framework of Diagnosis Related Groups and its application in performance evaluation, this paper examines how this payment model affects hospital performance appraisal systems across multiple dimensions, including medical cost control, service quality improvement, resource allocation efficiency, and management system optimization. The findings reveal that the Diagnosis Related Groups payment model serves as an effective tool for enhancing the fairness and scientificity of performance appraisal in public hospitals. It promotes standardized medical practices, improves the case mix index, shortens average length of stay, and strengthens the public welfare orientation of public hospitals. Furthermore, this study identifies key implementation strategies, including strengthening the quality control of inpatient medical record front sheets, leveraging information technology for performance management, improving internal hospital regulations, and enhancing the professional competence of management personnel. The results provide theoretical support and practical guidance for public hospitals seeking to optimize their performance appraisal systems under the Diagnosis Related Groups payment framework, ultimately contributing to the sustainable development of public healthcare institutions.

Keywords: medical insurance pressure, diagnosis related groups, public hospital, performance appraisal, healthcare reform, medical cost control, hospital management

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DOI: https://doi.org/10.5861/ijrsm.2026.26532

Cite this article:
Zuo, X., Zuo, Y., Wang, H., & Nurmagambetova, A. (2026). Research on the influence mechanism of medical insurance pressure on performance appraisal of public hospitals under the background of diagnosis related groups payment implementation. International Journal of Research Studies in Management, 14(4), 135-140. https://doi.org/10.5861/ijrsm.2026.26532

* Corresponding Author