Physicians' and Hospital Administrators' Perspectives of Diagnosis-Related Groups (DRGs) in High-Income Countries: A Systematic Review
Abstract
BACKGROUND: Diagnosis-related groups (DRGs) are among the most widely adopted case-mix-based hospital payment systems, introduced to improve efficiency, enhance cost transparency and contain rising healthcare expenditure. Although a substantial body of literature evaluates the economic and system-level effects of DRGs, comparatively less attention has been paid to the perspectives of healthcare providers who work within these reimbursement structures and directly experience their consequences in daily clinical practice.
OBJECTIVE: This systematic review synthesises evidence on physicians' and hospital administrators' perspectives of DRG-based payment systems in high-income countries, with particular attention to perceived effects on clinical decision-making, quality of care, administrative workload and professional autonomy. Nursing and allied health perspectives are identified as warranting a separate dedicated review and are not the focus of the present work.
METHODS: The review was conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD42024575025). Six electronic databases (PubMed, Scopus, Web of Science, CINAHL, Embase and ProQuest) were searched for English-language studies published between 1994 and 2024. Qualitative, quantitative and mixed-methods studies reporting provider or hospital-level perspectives on DRG implementation were included. Methodological quality was assessed using the Joanna Briggs Institute (JBI) appraisal tools and…
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