Purpose China developed an innovative episode-based payment scheme for outpatient care, namely “Ambulatory Patient Groups (APGs) + capitation” payment, to constrain inflation in outpatient expenditures. This study aimed to assess the effects of this payment method on volume and expenditures in Chinese public hospitals. Methods A quasi-experimental study was conducted with 7 municipal and 12 county hospitals from Jinhua as the intervention group and 15 municipal and 24 county hospitals from three neighbouring cities as the control group. The payment reform was introduced to municipal and county hospitals in the intervention group in January 2020 and January 2021, respectively. Monthly data on volumes and outpatient expenditures were collected from each hospital from January 2019 to December 2021. Controlled interrupted time-series analyses were performed to determine the effects of the funding reforms. Results Outpatient visits in municipal hospitals decreased by 1417.54 (p=0.048) per month on average compared with control ones after the reform was implemented, whilst that in county hospitals increased by 1058.04 (p=0.041) per month on average. The trend of drug expenditures ( β 7 =−1.41, p=0.019) in municipal hospitals dropped, which was accompanied by an immediate reduction in consumable expenditures ( β 6 =−6.89, p=0.044). The funding reform also led to the significant declines in drug ( β 6 =−10.96, p=0.009) and consumable ( β 6 =−4.78, p=0.041) expenditures in county hospitals. Municipal hospitals experienced the drop in the trend of total outpatient expenditures ( β 7 =−3.99, p=0.018) over the same period. Conclusion The strength of the “AGPs + capitation” payment for outpatient care lies in its ability to control the excessive growth of medical expenses through correcting inappropriate incentives. However, minimising potential cost-shifting and risk-shifting to uninsured service items should be given attention.
UNSTRUCTURED The urban-rural disparities in health outcomes in China is remarkable. The Internet has shown the potential to reduce the risk of disease. However, very little known on the effects of Internet use in alleviating urban-rural inequities. This study aims to examine mediation and moderation of health disparities between urban and rural old adults through Internet usage. Data were drawn from the China Health and Retirement Longitudinal Study 2018 dataset. Basic activities of daily living, brief Community Screening Instrument for Dementia and Centre for Epidemiologic Studies Depression Scale were used to measure functional disability, cognitive function and depressive symptoms, respectively. Logistic regressions testing “Internet usage*urban-rural status” interactions for moderation and Karlson–Holm–Breen (KHB) decomposition for mediation were performed. Internet use moderated the urban-rural disparities in cognitive function (OR=7.327, 95%CI: 3.011 to 17.832) and depressive symptoms (OR=1.070, 95%CI: 1.037 to 1.787), but the moderating effects were significant only for those using the Internet daily. KHB results showed the suppression effects of using the Internet daily (β=0.012, 95%CI: 0.002 to 0.021) existed in the association of urban-rural status with cognitive function. Part of the urban-rural disparity in depressive symptoms is attributed to the differences in Internet usage (β=-0.027, 95%CI: -0.043 to -0.009). The effect of urban-rural status on mental health among the elderly is moderated and mediated by Internet usage in China. Providing convenient channels for the rural elderly to use the Internet and promoting Internet popularity in rural areas are effective approaches to reducing urban-rural health inequalities.
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