Managing Urban Stroke Health Expenditures in China: Role of Payment Method and Hospital Level

Abstract

Background: Stroke is one of the leading public health issues in China and imposes a heavy financial burden on patients and the health care system. This study assess which payment method provides the lowest hospital costs for China’s health care system and the lowest out-of-pocket (OOP) expense for insured patients. Methods: This is a 4-year cross-sectional study. From the China Health Insurance Research Association database, a 5% random sample of urban health insurance claims was obtained. Descriptive analysis was conducted and a generalized linear model (GLM) with a gamma distribution and a log link was estimated. Results: For outpatients, capitation payment had the lowest hospital cost (RMB180.9/US$28.8) and lowest OOP expenses (RMB75.6/ US$12.0) per patient visit in primary hospitals compared with fee-for-service (FFS) payments. The global budget displayed the lowest total hospital costs (RMB344.7/US$54.8) in secondary hospitals, and was 27.39% (95% CI=-0.320, -0.289) lower than FFS. FFS had the lowest OOP expenses (RMB123.4/US$19.6 vs. RMB151.8/US$24.1) in secondary and tertiary hospitals. For inpatients, FFS had the lowest total hospital costs (RMB5,918.7/US$941.1) per visit and capitation payments had the lowest OOP expenses (RMB876.5/US$139.4, 40.10% lower than FFS, 95% CI=-0.579, -0.147) in primary hospitals. Capitation payment had both the lowest hospital costs (RMB7,342.9/US$1,167.5 vs. RMB17,711.7/US$2,816.2) and the lowest OOP expenses (RMB1,664.2/US$264.6 vs. RMB3,276.3/US$520.9) for both secondary and tertiary hospitals. Conclusion: For outpatients in primary hospitals and inpatients in secondary and tertiary hospitals, the capitation payment was the most money-saving payment method delivering both the lowest OOP expenses for patients and the lowest hospital total costs for hospitals. We recommend that health policymakers prioritize the 2implementation of the payment method with the lowest OOP expenses when the payment method does not deliver both the lowest hospital costs for the health system and lowest OOP expenses for patients.

Medical Insurance Payment Schemes and Patient Medical Expenses: A Cross- Sectional Study of Lung Cancer Patients in Urban China

“…The lowest OOP expenses for hospitalized patients was under CAP, which was consistent with previous ndings that OOP expenses for patients can be reduced through CAP [37], without weakening the quality of medical care [24]. Yang et al [15] argued that CAP won patient trust and reduced OOP expenses for patients. Table 3 shows that CAP had the second-highest hospital expenses, but the highest reimbursement rate under the four payment methods.…”

“…When payment schemes minimize both hospital and OOP expenses, we consider it a good payment method [15]. However, none of the four payment methods satis ed this dual condition in our study.…”

“…With its own risks, coverage, nancing policies, treatments, medical insurance catalogues, the management of designated hospitals and fund management [19], each payment method results in different hospital and OOP expenses, but all medical insurance payment methods have reduced average hospital expenses [15,31]. Previous studies on the economic burden of lung cancer have focused on regional costs, medical insurance types and in uencing factors, such as smoking and air quality [32][33][34],…”

Medical insurance payment schemes and patient medical expenses: a cross-sectional study of lung cancer patients in urban China

“…Basic medical insurance was mainly coordinated at the prefecture-level, and the payment methods varied by province. While basic medical insurance meant lung cancer out-of-pocket (OOP) medical expenses were reduced, the different fund arrangements saw OOP expenses vary by the medical insurance scheme and geographical region [13][14][15]. Within the basic medical insurance schemes, different insurance payment methods affect the supply and demand for medical services and the funding of health resources.…”

“…With its own risks, coverage, financing policies, treatments, medical insurance catalogues, the management of designated hospitals and fund management [19], each payment method results in different hospital and OOP expenses, but all medical insurance payment methods have reduced average hospital expenses [15,31]. Previous studies on the economic burden of lung cancer have focused on regional costs, medical insurance types and influencing factors, such as smoking and air quality [32][33][34], but this is the first study of the relationship between lung cancer expenses and alternative insurance payment methods.…”