Analysis of influencing factors and structural changes in hospitalization expenses for heart failure patients under the DRG payment system reform

Objective This study aimed to explore the influencing factors and structural changes in hospitalization expenses for heart failure (HF) patients under the Diagnosis-Related Group (DRG) payment system reform, providing a scientific basis for hospitals to control the hospitalization costs of HF patients. Methods A total of 4,791 hospitalized HF patients from a secondary Grade-A hospital in Liuzhou City between January 1, 2015, and July 31, 2025, were selected as the study subjects. Factors such as the timing of DRG implementation were grouped and included in the analysis. Univariate analysis and multiple linear regression were employed to analyze the influencing factors of total hospitalization expenses and out-of-pocket payments. The degree of structural change and novel gray relational analysis were used to examine the trends and correlations in the structure of hospitalization expenses for HF patients. Results The total hospitalization expenses of HF patients were mainly influenced by the type of medical insurance, number of visits, gender, age, length of stay, number of other diagnosed diseases, diabetes, surgery level, and discharge method ( P 0.05). Out-of-pocket payments were primarily affected by the payment method group, type of medical insurance, number of visits, gender, marital status, admission route, length of stay, and surgery level ( P 0.05). From 2015 to 2025, the treatment fee had the largest Variation of Structural Value (VSV) at 0.1663, showing a positive change, while the drug fee contributed the most to the structural change at 34.06%. The novel gray relational analysis indicated that the top two associated items were diagnosis fees (0.8797) and drug fees (0.7647), meaning that treatment, diagnosis, and drug fees were the main factors affecting the structural changes in hospitalization expenses. Conclusion The DRG payment system can effectively reduce the hospitalization expenses of HF patients, alleviating their disease burden. When controlling costs under the DRG payment system, comprehensive consideration should be given to influencing factors such as the patient's number of visits, length of stay, surgery level, gender, age, and number of other diagnosed diseases to effectively reduce hospitalization expenses. By utilizing DRG payments and medical insurance policies to manage and control diagnosis and drug fees of heart failure, hospitalization costs can be controlled, and the cost structure optimized.