The impact of urban health insurance reform on hospital charges: a case study from two cities in China

Meng, Qingyue; Rehnberg, Clas; Zhuang, Ning; Bian, Ying; Tomson, Göran; Tang, Shenglan

doi:10.1016/j.healthpol.2003.09.010

Cited by 37 publications

(25 citation statements)

References 21 publications

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“…Hospitals are divided by the government into three principal grades according to the Hospital Classification Guidelines based on the hospitals functions, tasks, facilities technology, and quality of medical services and the overall level of scientific management (China Ministry of Health 1989). The government also strictly regulates the level of medical charges under the payment guidelines established by the State Price Commission (Meng et al 2004). It determines and revises the fees for primary medical service items by the hospitals in each grade.…”

Section: Methodsmentioning

confidence: 99%

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Factors Related to the High Cesarean Section Rate and Their Effects on the "Price Transparency Policy" in Beijing, China

Hong

2007

Tohoku J. Exp. Med.

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In urban China, many non-clinically indicated cesarean sections (NCSs) are performed, resulting in an unnaturally high cesarean section (CS) rate. NCSs represent CSs without any specific medical indications. The demand for NCS may be due to women's preference for CS and their belief in its safety and comfortableness. In addition, CS is more profitable for the supply side than vaginal delivery, which results in a continued rise in delivery expenditures. As a result, the so-called "price transparency policy", which forces hospitals to declare their average hospital charges, was adopted to control the delivery expenditures in the ongoing Chinese healthcare reform policy. The purpose of this study is to prove that the supply and demand factors affect the choice of delivery modes and more resources are consumed in NCS. The data of 680 live deliveries were collected from three hospitals in Beijing. Multinomial logistic regression analyses were conducted to identify the factors related to choosing NCS, and ANOVA and ANCOVA were used to compare the charges, proxy for resource utilization, among the delivery modes or hospitals. The results showed that the high NCS rate (37.7%) might be predicted not only based on the demand factors (region of residence, parity, maternal age and weight gain) but also on the supply factors (hospital dummy, revenue-staff ratio, bed turnover rate and obstetric medical staffs-delivery ratio), suggesting that such induced NCSs result in an unnecessarily high resource consumption. These data suggest that the present Chinese policy fails to control delivery expenditures.China; choice of delivery modes; hospital charge; non-clinically indicated caesarean section (NCS); price transparency policy

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Section: Methodsmentioning

confidence: 99%

“…Cost data could not be collected from the sample hospitals. In addition, researchers still do not agree on the standard cost allocation (Tu et al 2002;Meng et al 2004). We therefore utilized the charge data as a proxy for resource utilization instead of the cost data.…”

Section: Methodsmentioning

confidence: 99%

Factors Related to the High Cesarean Section Rate and Their Effects on the "Price Transparency Policy" in Beijing, China

Hong

2007

Tohoku J. Exp. Med.

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“…For example, Meng et al report on a comparison between Nantong, an urban health insurance pilot city that implemented both provider payment reforms and new forms of contracting, and Zibo, a city that did not implement reforms. 40 They find a smaller cost-increase in Nantong, without measurable impact on quality. Similar results have been found in other studies.…”

Section: Prices and Provider Paymentmentioning

confidence: 97%

Health Service Delivery In China: A Literature Review

Eggleston¹,

Lindelöw²,

Li³

et al. 2006

Policy Research Working Papers

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We report the results of a review of the Chinese-language and English-language literatures on service delivery in China, asking how well China's health care providers perform, what determines their performance, and how the government can improve it. We find current performance leaves room for improvement, in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector, or by simply encouraging providers-public and private-to compete with one another for individual patients. By contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid-shifting away from fee-for-service and the distorted price schedule toward prospective payments. Active purchasing by insurers could further improve outcomes.

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“…A report (cited in Meng et al, 2004) notes that in wealthy areas child birth has increased at tertiary hospitals, thereby bypassing township or county hospitals.…”

Section: A Reality Check On the Resultsmentioning

confidence: 99%

“…Furthermore, the higher level of insurance coverage in a province like Jiangsu, and to a lesser extent in Shandong and Hunan, show that the regional diversity is a factor to be taken account with in sketching a picture of the Chinese health care sector. Jiangsu deserves some special mention as this is a province that has implemented a health insurance reform in 1997 which seems to have proven quite effective in controlling hospital charges and expenditures (Meng et al, 2004). However, as shown by Akin et al (2004) province behave differently in matters of health care demand.…”

Section: Here Tablementioning

confidence: 99%

When Health Care Insurance Does Not Make a Difference - the Case of Health Care 'Made in China'

Dalen

2006

SSRN Journal

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in AbstractDoes medical insurance affect health care demand and in the end contribute to improvements in the health status? Evidence for China for the year 2004, by means of the China Health and Nutrition Survey (CHNS), shows that health insurance does not affect health care demand in a significant manner. Counterfactuals suggest that full insurance coverage of the Chinese population will not radically change the health care decisions and may even enlarge the perverse effects of today's health care system: insured persons are more likely to fall back on self-care when they are injured or ill than on the care of a local clinic. This effect is particularly strong in urban areas. In case of a severe injury hospital consultation is preferred to local clinic or self-care by most people, but still a substantial percentage (20 percent) resorts to self-care or ignores the illness. The high level of out-of-pocket expenses paid by both insured and uninsured patients lies at the root of this problem. Insurance does not offer real protection against unpredictable high health care expenditures and can lead people into a position of long-term poverty or serious liquidity problems.* Comments by Frans Willekens are gratefully acknowledged.1

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The impact of urban health insurance reform on hospital charges: a case study from two cities in China

Cited by 37 publications

References 21 publications

Factors Related to the High Cesarean Section Rate and Their Effects on the "Price Transparency Policy" in Beijing, China

Factors Related to the High Cesarean Section Rate and Their Effects on the "Price Transparency Policy" in Beijing, China

Health Service Delivery In China: A Literature Review

When Health Care Insurance Does Not Make a Difference - the Case of Health Care 'Made in China'

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