The pilot of a new patient classification-based payment system in China: The impact on costs, length of stay and quality

Qian, Mengcen; Zhang, Xinyu; Chen, Yajing; Xu, Shengqiang; Ying, Xiaohua

doi:10.1016/j.socscimed.2021.114415

Cited by 26 publications

(24 citation statements)

References 18 publications

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“…Therefore, for some rehabilitation patients with high-medical demand that are extraordinarily costly compared with the other cases, a outlier payment is also needed. The over costly medical service provided during the hospitalization could be assigned to DIP (diagnosis-intervention packet) payment, which is a novel case-mix with a global budget payment system developed by China ( 45 ). Finally, a quality-based payment system for rehabilitation services should be further explored after various standards and assessment systems being improved.…”

Section: Discussionmentioning

confidence: 99%

Research on the Current Situation and Countermeasures of Inpatient Cost and Medical Insurance Payment Method for Rehabilitation Services in City S

Tang

Bian

et al. 2022

Front. Public Health

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ObjectiveThis study aimed to introduce bed-day payment for rehabilitation services in City S, China, and analyze the cost of inpatient rehabilitation services. Key issues were defined and relevant countermeasures were discussed.MethodsThe data about the rehabilitation cost of 3,828 inpatient patients from June 2018 to December 2019 was used. Descriptive statistics and the Kruskal–Wallis test were employed to describe sample characteristics and clarify the comparity of cost and length of stay (LOS) across different groups. After normalizing the distribution of cost and LOS by Box–Cox transformation, multiple linear regression was used to explore the factors influencing cost and LOS by calculating the variance inflation factor (VIF) to identify multicollinearity. Finally, 20 senior and middle management personnel of the hospitals were interviewed through a semi-structured interview method to further figure out the existing problems and countermeasures.Results(1) During 2015–2019: both discharges and the cost of rehabilitation hospitalization in City S rose rapidly. (2) The highest number of discharges were for circulatory system diseases (57.65%). Endocrine, nutritional, and metabolic diseases were noted to have the longest average length of stay (ALOS) reaching 105.8 days. The shortest ALOS was found to be 24.2 days from the diseases of the musculoskeletal system and connective tissue. Neurological, circulatory, urological, psychiatric, infectious, and parasitic diseases were observed to be generally more costly. (3) The cost of rehabilitation was determined to mainly consist of the rehabilitation fee (23.63%), comprehensive medical service fee (22.61%), and treatment fee (19.03%). (4) Type of disease, age, nature of the hospital, and grade of the hospital have significant influences both on cost and LOS (P < 0.05). The most critical factor affecting the cost was found to be the length of stay (standardized coefficient = 0.777). (5) The key issues of City S's rehabilitative services system were identified to be the incomplete criteria, imperfections in the payment system, and the fragmentation of services.ConclusionsBed-day payment is the main payment method for rehabilitation services, but there is a conflict between rapidly rising costs and increasing demand for rehabilitation. The main factors affecting the cost include the length of stay, type of disease, the grade of the hospital, etc. Lack of criteria, imperfections in the payment system, and the fragmentation of services limit sustainability. The core approach is to establish a three-tier rehabilitative network and innovate the current payment system.

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Section: Discussionmentioning

confidence: 99%

Research on the Current Situation and Countermeasures of Inpatient Cost and Medical Insurance Payment Method for Rehabilitation Services in City S

Tang

Bian

et al. 2022

Front. Public Health

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“…While it is common to use mutually exclusive clinical conditions in prior literature [ 45 ]. Still, we encourage future studies to include and yield further data, for example, the combination of primary diagnosis with procedure diagnosis [ 46 ] to better describe these complex profiles. Finally, we only analyzed data from the Shanghai Basic Social Medical Insurance Database, which limited the generalizability of the results to other areas of China.…”

Section: Discussionmentioning

confidence: 99%

Identifying patterns of clinical conditions among high-cost older adult health care users using claims data: a latent class approach

Wang

et al. 2022

Int J Equity Health

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Objectives To identify patterns of clinical conditions among high-cost older adults health care users and explore the associations between characteristics of high-cost older adults and patterns of clinical conditions. Methods We analyzed data from the Shanghai Basic Social Medical Insurance Database, China. A total of 2927 older adults aged 60 years and over were included as the analysis sample. We used latent class analysis to identify patterns of clinical conditions among high-cost older adults health care users. Multinomial logistic regression models were also used to determine the associations between demographic characteristics, insurance types, and patterns of clinical conditions. Results Five clinically distinctive subgroups of high-cost older adults emerged. Classes included “cerebrovascular diseases” (10.6% of high-cost older adults), “malignant tumor” (9.1%), “arthrosis” (8.8%), “ischemic heart disease” (7.4%), and “other sporadic diseases” (64.1%). Age, sex, and type of medical insurance were predictors of high-cost older adult subgroups. Conclusions Profiling patterns of clinical conditions among high-cost older adults is potentially useful as a first step to inform the development of tailored management and intervention strategies.

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“…The NHSA has also introduced “diagnostic‐intervention packet” (DIP) that relies on sophisticated analysis of historical healthcare and SHI data amassed at the local level. The DIP includes a price adjustment mechanism through which the actual reimbursement for each case is determined ex post, thus offering hospitals incentives to improve cost efficiency (Qian et al, 2021). The government expects the DRG/DIP payment system to cover all inpatient services by the end of 2025 and is currently rolling out policy pilots nationwide 7…”

Section: Healthcare Reforms In China: 2009–presentmentioning

confidence: 99%

Active stewardship in healthcare: Lessons from China's health policy reforms

Bali

Ramesh

2022

Soc Policy Adm

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Governments across the globe have made repeated attempts to reform their health systems in recent decades with the purpose of improving access while containing costs. What is the role of government in contemporary health policy in achieving these somewhat contradictory goals? This paper conceptualises this role as one of "active stewardship" wherein the government is a central actor steering and coordinating the sector through a portfolio of diverse policy tools. In this conceptualisation, the government is not a passive participant-in merely financing, delivering, or regulating the sector-but a steersman at the helm that sets policy objectives and actively pursues them. We argue that active stewardship is central to achieving contemporary health policy priorities of universal healthcare.We apply this conceptualisation to China's recent healthcare forms and show that the role of the government in governing the sector has changed substantially over time, particularly since 2009, and the changes are showing promising results. China's experience suggests that governments need to more actively guide and shape the behaviour of both public and private players in order to achieve the goals of universal health coverage. It also suggests that a high degree of policy capacity is essential if active stewardship is to be effective.

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The pilot of a new patient classification-based payment system in China: The impact on costs, length of stay and quality

Cited by 26 publications

References 18 publications

Research on the Current Situation and Countermeasures of Inpatient Cost and Medical Insurance Payment Method for Rehabilitation Services in City S

Research on the Current Situation and Countermeasures of Inpatient Cost and Medical Insurance Payment Method for Rehabilitation Services in City S

Identifying patterns of clinical conditions among high-cost older adult health care users using claims data: a latent class approach

Active stewardship in healthcare: Lessons from China's health policy reforms

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