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Medical Service Quality, Efficiency and Cost Control Effectiveness of Upgraded Case Payment in Rural China: A Retrospective Study

International journal of environmental research and public health, 2018-12, Vol.15 (12), p.2839 [Peer Reviewed Journal]

2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;2018 by the authors. 2018 ;ISSN: 1660-4601 ;ISSN: 1661-7827 ;EISSN: 1660-4601 ;DOI: 10.3390/ijerph15122839 ;PMID: 30551561

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Title:
Medical Service Quality, Efficiency and Cost Control Effectiveness of Upgraded Case Payment in Rural China: A Retrospective Study
Author: He, Ruibo ; Ye, Ting ; Wang, Jing ; Zhang, Yan ; Li, Zhong ; Niu, Yadong ; Zhang, Liang
Subjects: Budgets ; China ; Compensation ; Cost control ; Cost Control - legislation & jurisprudence ; Cost Control - standards ; Costs ; Disease ; Efficiency ; Efficiency, Organizational - statistics & numerical data ; Fees & charges ; GDP ; Gross Domestic Product ; Health care ; Health care delivery ; Health care expenditures ; Health care facilities ; Health care policy ; Health Expenditures - statistics & numerical data ; Health services ; Hospitalization - statistics & numerical data ; Hospitals ; Humans ; Insurance ; Insurance, Health, Reimbursement - statistics & numerical data ; Models, Economic ; Patient care planning ; Payments ; Population ; Quality of Health Care - standards ; Quality of Health Care - statistics & numerical data ; Quality of service ; Rural areas ; Rural environments ; Rural Population - statistics & numerical data ; Trends
Is Part Of: International journal of environmental research and public health, 2018-12, Vol.15 (12), p.2839
Description: As the principal means of reimbursing medical institutions, the effects of case payment still need to be evaluated due to special environments and short exploration periods, especially in rural China. Xi County was chosen as the intervention group, with 36,104, 48,316, and 59,087 inpatients from the years 2011 to 2013, respectively. Huaibin County acted as the control group, with 33,073, 48,122, and 51,325 inpatients, respectively, from the same period. The inpatients' information was collected from local insurance agencies. After controlling for age, gender, institution level, season fixed effects, disease severity, and compensation type, the generalised additive models (GAMs) and difference-in-differences approach (DID) were used to measure the changing trends and policy net effects from two levels (the whole county level and each institution level) and three dimensions (cost, quality and efficiency). At the whole-county level, the cost-related indicators of the intervention group showed downward trends compared to the control group. Total spending, reimbursement fee and out-of-pocket expense declined by ¥346.59 ( < 0.001), ¥105.39 ( < 0.001) and ¥241.2 ( < 0.001), respectively (the symbol ¥ represents Chinese yuan). Actual compensation ratio, length of stay, and readmission rates exhibited ascending trends, with increases of 7% ( < 0.001), 2.18 days ( < 0.001), and 1.5% ( < 0.001), respectively. The intervention group at county level hospital had greater length of stay reduction (¥792.97 < 0.001) and readmission rate growth (3.3% < 0.001) and lower reimbursement fee reduction (¥150.16 < 0.001) and length of stay growth (1.24 days < 0.001) than those at the township level. Upgraded case payment is more reasonable and suitable for rural areas than simple quota payment or cap payment. It has successfully curbed the growth of medical expenses, improved the efficiency of medical insurance fund utilisation, and alleviated patients' economic burden of disease. However, no positive effects on service quality and efficiency were observed. The increase in readmission rate and potential hidden dangers for primary health care institutions should be given attention.
Publisher: Switzerland: MDPI AG
Language: English
Identifier: ISSN: 1660-4601
ISSN: 1661-7827
EISSN: 1660-4601
DOI: 10.3390/ijerph15122839
PMID: 30551561
Source: Geneva Foundation Free Medical Journals at publisher websites
MEDLINE
PubMed Central
ProQuest Central

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Medical Service Quality, Efficiency and Cost Control Effectiveness of Upgraded Case Payment in Rural China: A Retrospective Study

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