The effect of basic medical insurance on the changes of primary care seeking behavior: An application of hierarchical age-period-cohort analysis

Cao, Na; Li, Xuyang; Jiang, Junfeng; Xu, Wenyan

doi:10.3389/fpubh.2022.929896

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…Thus, primary care physicians are fully capable of performing the diagnosis, treatment, and follow-up management of this disease. In order to encourage residents to seek medical services at primary care facilities, China has formulated a tiered diagnosis and treatment policy as well as differentiated health insurance reimbursement rates [40,41]. However, to a certain extent, the results of the present study demonstrate that the implementation of the two policies is not very effective.…”

Section: Discussionmentioning

confidence: 58%

A study on curative care expenditure and the financing burden from different comorbidity states of chronic hepatitis B

Wei,

Fan,

Yang

et al. 2023

Preprint

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Background The hepatitis B incidence rate has dropped significantly in China recent years. However, the number of hepatitis B virus carriers and infected people is still relatively high due to the extensive population base. The study calculated the curative care expenditure and financing burden from different comorbidity states of chronic hepatitis B in Sichuan Province, to provide a reference for the relevant government departments to invest in the prevention and treatment of infectious diseases, and to optimize health insurance protection measures for this disease. Methods Data on the CCE of 242,749 CHB patients were collected from 1,600 healthcare institutions in Sichuan Province in 2019 using a multistage stratified random sampling method. Based on the System of Health Accounts 2011, the CCE of CHB in different comorbidity states was calculated from the dimensions of service function, financing schemes, institutional flows, and beneficiary group distribution. Results The total CCE of CHB in Sichuan Province in 2019 was USD 85.49 million. Most of the total CCE (USD 67.16 million) was spent on outpatient services, whereby the main source of financing for the outpatient expenditure was household out-of-pocket payment (75.71%). Conversely, the CCE for inpatient services (USD 18.33 million) was mainly financed by public financing schemes (46.38%). More than 70% of the CCE flowed to general hospitals, and less than 20% flowed to primary healthcare institutions, while the CCE varied significantly among different comorbidity groups. In this case, the CCE for patients with no additional comorbidities and those in the low comorbidity group was mainly spent on patients under the age of around 35 years and those in the 40–49 age group, respectively, while the CCE in the high comorbidity group was mainly used for patients aged around 50 or 55 years. Conclusions The present study shows that a high proportion of the CCE allotted to CHB is financed by household out-of-pocket payment; this situation poses a heavy medical burden on individuals. Therefore, the financing structure needs to be optimized urgently. Overall, it is imperative to continuously improve the outpatient mutual aid protection mechanism, effectively improve the curative rate for antiviral treatments aimed at CHB.

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Section: Discussionmentioning

confidence: 58%

A study on curative care expenditure and the financing burden from different comorbidity states of chronic hepatitis B

Wei,

Fan,

Yang

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Moreover, access to primary care has improved following initiation of the State Council’s extensive healthcare reforms, leading to the attainment of UHC for healthcare at all levels ( 24 ). The majority of case-based payments to GPs and hospital specialists are covered by national medical insurance ( 25 ). However, our study identified several barriers, including lengthy wait lists, low acceptance of GP referrals for public programs, financial constraints associated with private programs, and limited accessibility of local programs.…”

Section: Discussionmentioning

confidence: 99%

General practice management of chronic post-surgical pain in patients with hip fracture: a qualitative study

Cao,

Ye,

Yan

et al. 2024

Front. Med.

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BackgroundHip fractures are common among elderly people and often lead to chronic post-surgical pain (CPSP). Effective CPSP management when patients transition from hospital to community settings is essential, but has not been sufficiently researched. This study examined general practitioner (GP) perspectives on managing patients with CPSP after hip fractures in Shanghai, China.MethodsA descriptive qualitative study was performed wherein semi-structured interviews were conducted with GPs practicing in Shanghai who volunteered to participate. This study was initiated after a regional survey of general practice care for patients with CPSP following hip fracture.ResultsSix key themes emerged: (1) GPs’ care priorities for patients with CPSP varied; (2) pharmacological management posed challenges in terms of selecting appropriate medications; (3) consultation time constraints hindered comprehensive management; (4) GPs desired better communication from hospitals at discharge; (5) limited access to services, such as pain specialists and allied health, obstructed optimal care delivery; and (6) patient nonadherence to CPSP treatment was an issue.ConclusionMultiple patient-, provider-, and system-level factors affected GP care for patients with CPSP after hip fracture. Improved interdisciplinary communication and education on evidence-based CPSP guidelines are needed to address the knowledge gaps among GPs. Barriers to healthcare access must be minimized to facilitate guideline-based care.

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“…In China, medical insurance reimbursement is one of the most important tools to guide patients to rational medical care, and the behavior of patients' medical needs is regulated and promoted by differentiated medical insurance reimbursement policy. One study showed that the higher the reimbursement rate of a medical institution, the greater its ability to attract residents to medical care [ 33 ]. Medical service fees should be designed in combination with measures such as family doctor system, chronic disease management, differentiated reimbursement of medical insurance, long prescriptions for essential medicines, and docking with drug catalogs in secondary and tertiary hospitals in order to coordinate the flow direction of patients with chronic diseases from tertiary hospitals to primary hospitals to further promote the effectiveness of hierarchical diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

Agent-Based Modeling and Simulation (ABMS)on the influence of adjusting medical service fees on patients' choice of medical treatment

Li,

Yang,

et al. 2023

BMC Health Serv Res

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Background We explored the impact of medical service fee adjustments on the choice of medical treatment for hypertensive patients in Beijing. We hope to provide decision-making reference to promote the realization of hierarchical diagnosis and treatment in Beijing. Methods According to the framework of modeling simulation research and based on the data of residents and medical institutions in Beijing, we designed three models of residents model, disease model and hospital model respectively. We then constructed a state map of patients’ selection of medical treatment and adjusted the medical service fee to observe outpatient selection behaviors of hypertensive patients at different levels of hospitals and to find the optimal decision-making plan. Results The simulation results show that the adjustment of medical service fees can affect the proportion of patients seeking medical treatment in primary and tertiary hospitals to a certain extent, but has little effect on the proportion of patients receiving medical treatment in secondary hospitals. Conclusions Beijing can make adjustments of the current medical service fees by reducing fees in primary hospitals and slightly increasing fees in tertiary hospitals, and in this way could increase the number of patients with hypertension in the primary hospitals.

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The effect of basic medical insurance on the changes of primary care seeking behavior: An application of hierarchical age-period-cohort analysis

Cited by 8 publications

References 32 publications

A study on curative care expenditure and the financing burden from different comorbidity states of chronic hepatitis B

A study on curative care expenditure and the financing burden from different comorbidity states of chronic hepatitis B

General practice management of chronic post-surgical pain in patients with hip fracture: a qualitative study

Agent-Based Modeling and Simulation (ABMS)on the influence of adjusting medical service fees on patients' choice of medical treatment

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