Medical Service Quality, Efficiency and Cost Control Effectiveness of Upgraded Case Payment in Rural China: A Retrospective Study
Abstract
:1. Introduction
2. Methods
2.1. Study Setting and Intervention Assignment
2.2. Study Design and Variables
2.3. Statistical Analyses
2.4. Ethics Statement
3. Results
3.1. Study Sample Characteristics
3.2. Policy Effects Shown by Observing Smooth Curve Trend
3.3. Policy Effects Observed from Difference-In-Differences Approach (DID) Model Outcomes
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Indicators | Xi County | Huaibin County |
---|---|---|
Location | Contiguous to Huaibin | Contiguous to Xi |
Administrative districts | 21 | 19 |
Urbanization rate (%) | 35.7 | 36.2 |
Permanent resident population (thousand) | 833.5 | 565.7 |
Per capita annual income (yuan) | 13,235 | 12,946 |
Number of county-level hospitals | 3 | 3 |
Number of township hospitals | 20 | 19 |
Number of hospital beds (per thousand population) | 2.05 | 2.38 |
Number of practitioners (per thousand population) | 1.36 | 1.48 |
Number of nurses (per thousand population) | 1.07 | 1.11 |
Baseline (2011) | Follow-Up (2013) | |||||
---|---|---|---|---|---|---|
Xi (Intervention) | Huaibin (Control) | p | Xi (Intervention) | Huaibin (Control) | p | |
N | 36,104 | 33,073 | 59,087 | 51,325 | ||
Gender | <0.001 | <0.001 | ||||
Male | 15,173 (42.03%) | 14,270 (43.15%) | 25,816 (43.69%) | 21,577 (42.04%) | ||
Female | 20,931 (57.97%) | 18,803 (56.85%) | 33,271 (56.31%) | 29,748 (57.96%) | ||
Age group | <0.001 | <0.001 | ||||
0–17 | 4897 (13.56%) | 2944 (8.90%) | 6630 (11.22%) | 3887 (7.57%) | ||
18–34 | 9973 (27.62%) | 6605 (19.97%) | 12,711 (21.51%) | 11,388 (22.19%) | ||
35–64 | 13,477 (37.33%) | 15,554 (47.03%) | 23,820 (40.31%) | 23,078 (44.96%) | ||
≥65 | 7757 (21.49%) | 7970 (24.09%) | 15,926 (26.95%) | 12,972 (25.27%) | ||
Institution level | <0.001 | <0.001 | ||||
Township level | 17,921 (49.64%) | 19,179 (57.99%) | 24,788 (41.95%) | 25,212 (49.12%) | ||
County level | 18,183 (50.36%) | 13,894 (42.01%) | 34,299 (58.05%) | 26,113 (50.88%) | ||
Total spending (¥) | 2451.26 | 2103.90 | <0.001 | 2690.09 | 3066.93 | <0.001 |
Reimbursement fee (¥) | 1302.53 | 1264.99 | <0.001 | 1841.45 | 1898.87 | <0.001 |
Out-of-pocket expense (¥) | 1148.73 | 838.91 | <0.001 | 848.65 | 1168.06 | <0.001 |
Compensation ratio (%) | 54.27 | 59.17 | <0.001 | 69.46 | 59.18 | <0.001 |
Length of stay (days) | 7.05 | 7.71 | 0.558 | 9.43 | 7.85 | <0.001 |
Readmission | <0.001 | <0.001 | ||||
No | 35,006 (96.96%) | 31,492 (95.22%) | 55,853 (94.53%) | 48,804 (95.09%) | ||
Yes | 1098 (3.04%) | 1581 (4.78%) | 3234 (5.47%) | 2521 (4.91%) |
Outcome Variable | 2011 (Baseline) | 2013 (Follow-up) | Difference-in-Differences | ||||
---|---|---|---|---|---|---|---|
Intervention | Control | Difference | Intervention | Control | Difference | ||
Whole county | |||||||
Total spending | 1602.12 | 1180.07 | 422.04 *** | 2212.46 | 2137.01 | 75.45 *** | −346.59 *** |
Reimbursement fee | 615.03 | 513.20 | 101.83 *** | 1137.61 | 1141.17 | −3.56 | −105.39 *** |
Out of pocket expense | 987.09 | 666.87 | 320.21 *** | 1074.85 | 995.84 | 79.01 *** | −241.20 *** |
Compensation rate | 0.448 | 0.487 | −0.039 *** | 0.517 | 0.486 | 0.031 *** | 0.070 *** |
Length of stay | 3.41 | 4.08 | −0.67 *** | 4.89 | 3.38 | 1.51 *** | 2.18 *** |
Readmission rate | 0.013 | 0.028 | −0.016 *** | 0.029 | 0.030 | −0.001 | 0.015 *** |
County hospital | |||||||
Total spending | 1629.48 | 938.26 | 691.22 *** | 1666.02 | 1917.94 | −251.92 *** | −943.14 *** |
Reimbursement fee | 440.97 | 361.51 | 79.46 *** | 815.77 | 886.47 | −70.70 *** | −150.16 *** |
Out-of-pocket expense | 1188.51 | 576.75 | 611.75 *** | 850.25 | 1031.47 | −181.22 *** | −792.97 *** |
Compensation rate | 0.397 | 0.497 | −0.100 *** | 0.498 | 0.454 | 0.044 *** | 0.144 *** |
Length of stay | 1.52 | 2.30 | −0.78 *** | 2.30 | 1.84 | 0.46 *** | 1.24 *** |
Readmission rate | 0.005 | 0.025 | −0.020 *** | 0.046 | 0.034 | 0.013 *** | 0.033 *** |
Township health centre | |||||||
Total spending | 1124.59 | 1073.83 | 50.76 *** | 566.08 | 1735.87 | −1169.79 *** | −1220.55 *** |
Reimbursement fee | 605.99 | 534.28 | 71.71 *** | 379.19 | 1125.70 | −746.51 *** | −818.22 *** |
Out-of-pocket expense | 518.60 | 539.54 | −20.94 *** | 186.89 | 610.17 | −423.28 *** | −402.34 *** |
Compensation rate | 0.558 | 0.536 | 0.022 *** | 0.745 | 0.587 | 0.159 *** | 0.137 *** |
Length of stay | 3.17 | 3.87 | −0.70 *** | 6.66 | 2.91 | 3.75 *** | 4.45 *** |
Readmission rate | 0.019 | 0.030 | −0.011 *** | 0.008 | 0.027 | −0.016 *** | −0.005 |
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He, R.; Ye, T.; Wang, J.; Zhang, Y.; Li, Z.; Niu, Y.; Zhang, L. Medical Service Quality, Efficiency and Cost Control Effectiveness of Upgraded Case Payment in Rural China: A Retrospective Study. Int. J. Environ. Res. Public Health 2018, 15, 2839. https://doi.org/10.3390/ijerph15122839
He R, Ye T, Wang J, Zhang Y, Li Z, Niu Y, Zhang L. 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; 15(12):2839. https://doi.org/10.3390/ijerph15122839
Chicago/Turabian StyleHe, Ruibo, Ting Ye, Jing Wang, Yan Zhang, Zhong Li, Yadong Niu, and Liang Zhang. 2018. "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 15, no. 12: 2839. https://doi.org/10.3390/ijerph15122839