DRG payment reform reshapes hospital consumables managers’ work in China

A mixed-methods study of hospital consumables managers in China has found that the rollout of diagnosis-related group (DRG)-based prospective payment is changing what these frontline staff do every day, shifting their focus from making sure supplies are available to managing costs, and in some cases leaving them relying on informal workarounds when systems and support fall short.

Researchers carried out an explanatory sequential mixed-methods study in three tertiary university-affiliated hospitals in China. They first ran a census survey of consumables managers covering 140 respondents, which assessed five domains: changes in job responsibilities, adaptation to organizational change, professional competence and training needs, information systems, and job satisfaction. The team examined measurement properties, correlations, and ordinary least squares regression, and then used the survey results to inform semistructured interviews with 14 purposively sampled managers.

The qualitative data were analyzed using Colaizzi’s method and integrated with the quantitative findings through joint displays guided by the job demands–resources model. The study was published in BMC Health Services Research as open access research, with the article shared early as a citable, peer-reviewed accepted version carrying a permanent DOI.

On the measurement side, the testing favored the five-domain model, although the authors note that discriminant validity was only partially supported. In the regression analysis, after adjustment for the other included domains, three domains were positively associated with job satisfaction: adaptation to organizational change (β = 0.386; p < 0.001), professional competence and training needs (β = 0.198; p = 0.017), and information systems (β = 0.412; p < 0.001). Changes in job responsibilities, by contrast, were not significantly associated with job satisfaction (β = −0.076; p = 0.089).

Sensitivity analyses added nuance to these results. They indicated substantial shared explanatory variance between adaptation to organizational change and professional competence and training needs, meaning the separate contributions of these two domains are difficult to disentangle. The association between information systems and job satisfaction, however, remained relatively stable across the analyses, suggesting that the quality of technological support may be a comparatively distinct factor in how these managers feel about their work.

The interviews painted a detailed picture of how DRG implementation is reshaping the role. Participants described a shift from supply assurance to cost management as the core of their job. They also reported a misalignment between day-to-day workflows and documentation requirements, a sense of perceived personal accountability for billing and compliance-related problems, and the use of informal workarounds to cope when formal processes and tools did not keep pace with the new demands placed on them.

When asked what would help, the managers emphasized concrete forms of support. They called for interoperable information systems, practice-oriented training, standardized workflows, clearer responsibility boundaries, and stronger cross-departmental coordination. These priorities align with the quantitative finding that information systems showed the largest adjusted association with job satisfaction, and they underline that the workforce dimension of payment reform is not simply a matter of individual resilience but of organizational and technological design.

The study’s conclusions frame workforce consequences as an important component of DRG implementation. According to the authors, when technological and organizational support is insufficient, frontline staff may experience greater personal accountability pressure and greater reliance on individual coping strategies. Aligning payment reform with interoperable systems, practice-oriented training, clear responsibilities, and coordinated organizational support may, they suggest, facilitate more sustainable implementation of the reform.

DRG-based prospective payments are being implemented in China as a value-oriented provider-payment reform intended to promote cost-conscious, standardized care.

The findings come with scope conditions worth noting. The survey covered consumables managers at three tertiary university-affiliated hospitals, and the qualitative phase involved 14 purposively sampled participants, so the results describe these settings rather than the full range of Chinese hospitals. The measurement model’s discriminant validity was only partially supported, and the sensitivity analyses flagged overlap between two of the domains. Even so, the combined evidence points to a consistent theme: as payment reform pushes cost management into everyday hospital operations, the people who manage consumables need systems, training, and organizational structures that match their new responsibilities.

Subject of Research: Workforce consequences of DRG-based hospital payment reform for consumables managers in China

Article Title: Workforce consequences of implementing DRG-based payment reform in China: an explanatory sequential mixed-methods study of hospital consumables managers

Article References: Zheng, X., Chen, D., Yue, M., Wei, J., Ren, X., Zhou, S., & Rao, H. (2026). Workforce consequences of implementing DRG-based payment reform in China: an explanatory sequential mixed-methods study of hospital consumables managers. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15937-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15937-6

Keywords: DRG payment reform, China, hospital consumables managers, job satisfaction, mixed-methods study, information systems, organizational adaptation, training needs, cost management, health workforce, BMC Health Services Research, Workforce