Reducing the medical economic burden of health insurance in China: Achievements and challenges

Dou, Guanshen; Wang, Qun; Ying, Xiaohua

doi:10.5582/bst.2018.01054

Cited by 54 publications

(51 citation statements)

References 16 publications

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“…The State Council of China increased investments to deepen the health-care system reform between 2009 and 2011 [23,24]. This reform focused on five aspects: basic medical security system, essential medicine system, grassroots health care services system, equity of (See figure on previous page.)…”

Section: Discussionmentioning

confidence: 99%

Trend of disparity between coastland and inland in medical expenditure burden for rural inpatients with malignant tumor in southeast of China from 2007 to 2016

Lin

et al. 2020

BMC Cancer

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Background: New Rural Cooperative Medical Scheme (NRCMS) was developed to improve the health security for rural residents. This study aimed to assess the trend of disparity between coastland and inland in medical expenditure burden for rural inpatients with malignant tumor from 2007 to 2016 under the effect of NRCMS. Methods: The data from medical records of 1,306,895 patients with malignant tumor who had NRCMS in 2932 hospitals was collected. The relative differences [95% confidence intervals (CIs)] between coastland and inland in four medical expense indicators were calculated using generalized linear models to assess the trend of disparity over time. Results: In total, there were 769,484 (58.88%) coastland patients and 537,411 (41.12%) inland patients. Male and patients aged older than 44 years accounted for 56.87 and 80% of 1,306,895 patients, respectively. After adjusting for gender, age, tumor site and hospital level, coastland patients had higher hospitalization expenses which were all medical expenses incurred during the hospitalization, lower reimbursement ratio and ratio of out-of-pocket expenses to disposable income than inland patients in most years. The surgery expenses of coastland patients were lower than those of inland patients in 2016. The relative differences (95% CIs) between coastland and inland in medical expense indicators were moving closer to 1.0 from 2007 to 2010 among patients without surgery, implying that the disparity between two areas significantly narrowed. The range of change was similar between two areas from 2011 to 2016 whether among patients without or with surgery, implying that the disparity did not significantly change. The disparity between coastland and inland depended on the household income situation. For low-income patients, the differences between two areas in medical expense indicators were not statistically significance in most cases and the disparity between two areas did not significantly change over time.

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Section: Discussionmentioning

confidence: 99%

Trend of disparity between coastland and inland in medical expenditure burden for rural inpatients with malignant tumor in southeast of China from 2007 to 2016

Lin

et al. 2020

BMC Cancer

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“…However, simultaneous bilateral TKA and THA and staged bilateral TKA and THA (calculate two surgical operations and reimbursed twice) are currently classi ed under the same Diagnosis Related Groups (DRGs), which means that they are reimbursed at the same level. Since medical insurance is the primary payer for patients in China [33], there needs reclassi cation of medical insurance items about these two procedures.…”

Section: Discussionmentioning

confidence: 99%

Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty: a university affiliated hospital survey of 1579 Chinese patients

Hou

Zhang³

et al. 2020

Preprint

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Background Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are required for many patients. No recent studies that concentrate on the costs for each of the payment items both for TKA and THA when comparing simultaneous bilateral procedures with staged arthroplasty. This study aimed to evaluate the medical costs, length of stay(LOS), blood transfusion, and in-hospital complications in patients undergoing simultaneous TKA or THA and staged TKA or THA. Methods A retrospective cohort study was conducted by analyzing 1,579 patients from a single institution. All patients who underwent primary bilateral TKA or THA from 2013 to 2018 were divided into three groups: TKA,THA and all patients. Then, we grouping simultaneous bilateral groups and staged bilateral groups in these three groups respectively. Finally, these two sub-groups(simultaneous bilateral groups and staged bilateral groups) were compared between the three groups(TKA, THA, and pooled groups). Results All categories of medical costs, except for materials fees which were higher in the simultaneous bilateral THA and pooled groups but with no statistical significance, were lower in the simultaneous TKA, THA and pooled simultaneous groups. The total average medical costs in simultaneous and staged bilateral TKA groups were $15,535.621and $16,747.192, p <0.001), respectively; THA groups were $15,046.210 and $16,126.808, ( p =0.003), respectively; pooled groups were $16,506.971and $15,467.561, ( p <0.001), respectively. All costs were presented in the United States dollar. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common co-morbidities and postoperative complications between the two sub-groups in three groups. The simultaneous groups had a shorter LOS, a higher incidence of blood transfusion than staged groups whether it is TKA groups or THA or pooled groups. Conclusions These results indicate that simultaneous bilateral TKA and THA with a shorter LOS is more economical than staged bilateral TKA and THA. Counts of complications were not affected by the choice for staged or simultaneous bilateral total arthroplasty. But blood transfusion was more prevalent in the simultaneous groups both for TKA and THA.

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“…The main problems faced by HTA in China include a lack of legal support, national HTA centers, relevant process mechanisms, discipline talents and funding inputs (7). Since 2015, with the advancement of China's medical insurance payment methods and the reform of the compensation mechanism of public hospitals (8,9). HTA has been applied for the first time in such fields as price negotiation regarding high-priced drugs in China, centralized procurement of high-value consumables and evaluation of new technologies, which has enabled HTA in China to enter a new development stage.…”

Section: Introductionmentioning

confidence: 99%

Driving factors and mode transformation regarding health technology assessment (HTA) in China: Problems and recommendations

Wang

Jin

Bai

et al. 2019

BST

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As the reform of Chinese medical and health undertakings has advanced (since 2015), the admission, pricing and payment policies regarding the new health technologies of China have undergone significant changes, and health technology assessment (HTA) has gradually become one of the current reform and research hotspots in China. Based on the perspective of HTA driving factors and the development mode, this paper proposes a two-stage mode of HTA development in China, namely, the mode driven by the management of new heath technology admission and another one driven by new health technology pricing and medical insurance payment. In addition, the paper also proposes the challenges that HTA faces in China under the current mode, including the development system, process standard, data mechanism, and policy application. Besides, recommendations are provided for the further development of HTA construction in China, including strengthening the development system of regional HTA centers, formulating HTA process guidance, building a database, improving evaluation quality and intensifying policy integration.

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Reducing the medical economic burden of health insurance in China: Achievements and challenges

Cited by 54 publications

References 16 publications

Trend of disparity between coastland and inland in medical expenditure burden for rural inpatients with malignant tumor in southeast of China from 2007 to 2016

Trend of disparity between coastland and inland in medical expenditure burden for rural inpatients with malignant tumor in southeast of China from 2007 to 2016

Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty: a university affiliated hospital survey of 1579 Chinese patients

Driving factors and mode transformation regarding health technology assessment (HTA) in China: Problems and recommendations

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