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ObjectivesTo determine insurance-related disparities in hospital care for patients with acute myocardial infarction (AMI), heart failure (HF) and pneumonia.Setting and participantsA total of 22 392 patients with AMI, 8056 patients with HF and 17 161 patients with pneumonia were selected from 31 tertiary hospitals in Shanxi, China, from 2014 to 2015 using the International Classification of Diseases, Tenth Revision codes. Patients were stratified by health insurance status, namely, urban employee-based basic medical insurance (UEBMI), urban resident-based basic medical insurance (URBMI), new cooperative medical scheme (NCMS) and self-payment.Outcome measuresInhospital mortality and length of stay (LOS).ResultsThe highest unadjusted inhospital mortality rate was detected in NCMS patients independent of medical conditions (4.7%, 4.4% and 11.1% for AMI, HF and pneumonia, respectively). The lowest unadjusted inhospital mortality rate and the longest LOS were observed in UEBMI patients. After controlling patient-level and hospital-level covariates, the adjusted inhospital mortality was significantly higher for NCMS and self-payment among patients with AMI, for NCMS among patients with HF and for URBMI, NCMS and self-payment among patients with pneumonia compared with UEBMI. The LOS of the URBMI, NCMS and self-payment groups was significantly shorter than that of the UEBMI group.ConclusionInsurance-related disparities in hospital care for patients with three common medical conditions were observed in this study. NCMS patients had significantly higher adjusted inhospital mortality and shorter LOS compared with UEBMI patients. Policies on minimising the disparities among different insurance schemes should be established by the government.

This study compares risk-standardized mortality rates (RSMRs) of patients with acute myocardial infarction among tertiary A (typically, advanced urban hospitals with more than 800 beds), tertiary B (urban hospitals with more than 500 beds), and secondary A hospitals (rural and urban hospitals with less than 500 beds) in Shanxi, China. In all, 43 500 acute myocardial infarction inpatient records from 93 hospitals were included. Hierarchical logistic regression was used to estimate RSMRs, and Dunn's post hoc test was used to make pairwise comparisons of RSMR between hospital levels. It was found that the median RSMRs of secondary A hospitals were significantly lower than those of tertiary A and tertiary B hospitals (at 1% and 10% significance level, respectively), while there was no significant difference between the median RSMRs in tertiary A and tertiary B hospitals. The reasons for significant disparity in quality of care among different hospital levels requires further exploration.

Objective:To assess the effect of the medical consortium policy on the outcomes of cancer patients admitted to secondary hospitals in Shanxi, China.Method:Electronic medical records of lung cancer (n = 8,193), stomach cancer (n = 5,693) and esophagus cancer (n = 2,802) patients hospitalized in secondary hospitals were used. Propensity score matching was used to match each patient enrolled in medical consortium hospitals with a counterpart admitted in non-medical consortium hospitals. Cox proportional hazard models were used to estimate the hazard ratio of patients enrolled different categories of hospitals.Results:The hazards of lung, stomach and esophageal cancer patients admitted in medical consortium hospitals were consistently and significantly lower than those admitted in non-medical consortium hospitals after adjusting for a number of potential confounders. Lower hazard ratios were associated with lung (hazard ratio (HR) = 0.533, p < 0.001), stomach (HR = 0.494, p < 0.001), and esophagus (HR = 0.505, p < 0.001) cancer patients in medical consortium hospitals.Conclusion:The medical consortium provides an effective strategy to improve the outcomes of cancer patients in Shanxi, China. The partnerships between top-tier hospitals and grassroots medical services bridge the gap in resources and plays a critical role in the quality of care in China.

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