Does a new case-based payment system promote the construction of the ordered health delivery system? Evidence from a pilot city in China

Shi, Huanyu; Cheng, Zhichao; Liu, Zhichao; Zhang, Yang; Zhang, Peng

doi:10.1186/s12939-024-02146-y

Cited by 3 publications

(1 citation statement)

References 55 publications

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“…Guangzhou City saw short-term success slowing spending growth [ 34 ], while Chengdu City witnessed decreased average expenditure per hospital admission increase and improved medical quality post-reform [ 35 ]. One research in Taian City suggested utilization decreased at primary hospitals with less efficient resource use [ 36 ]. The DIP’s role remains unclear due to inconsistent evidence.…”

Section: Introductionmentioning

confidence: 99%

The impact of an innovative payment method on medical expenditure, efficiency, and quality for inpatients with different types of medical insurance: evidence from a pilot city, China

Lin,

Li,

Yao

et al. 2024

Int J Equity Health

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Background Since 2020, China has implemented an innovative payment method called Diagnosis-Intervention Packet (DIP) in 71 cities nationwide. This study aims to assess the impact of DIP on medical expenditure, efficiency, and quality for inpatients covered by the Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI). It seeks to explore whether there are differences in these effects among inpatients of the two insurance types, thereby further understanding its implications for health equity. Materials and methods We conducted interrupted time series analyses on outcome variables reflecting medical expenditure, efficiency, and quality for both UEBMI and URRBMI inpatients, based on a dataset comprising 621,125 inpatient reimbursement records spanning from June 2019 to June 2023 in City A. This dataset included 110,656 records for UEBMI inpatients and 510,469 records for URRBMI inpatients. Results After the reform, the average expenditure per hospital admission for UEBMI inpatients did not significantly differ but continued to follow an upward pattern. In contrast, for URRBMI inpatients, the trend shifted from increasing before the reform to decreasing after the reform, with a decline of 0.5%. The average length of stay for UEBMI showed no significant changes after the reform, whereas there was a noticeable downward trend in the average length of stay for URRBMI. The out-of-pocket expenditure (OOP) per hospital admission, 7-day all-cause readmission rate and 30-day all-cause readmission rate for both UEBMI and URRBMI inpatients showed a downward trend after the reform. Conclusion The DIP reform implemented different upper limits on budgets based on the type of medical insurance, leading to varying post-treatment prices for UEBMI and URRBMI inpatients within the same DIP group. After the DIP reform, the average expenditure per hospital admission and the average length of stay remained unchanged for UEBMI inpatients, whereas URRBMI inpatients experienced a decrease. This trend has sparked concerns about hospitals potentially favoring UEBMI inpatients. Encouragingly, both UEBMI and URRBMI inpatients have seen positive outcomes in terms of alleviating patient financial burdens and enhancing the quality of care.

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Section: Introductionmentioning

confidence: 99%

The impact of an innovative payment method on medical expenditure, efficiency, and quality for inpatients with different types of medical insurance: evidence from a pilot city, China

Lin,

Li,

Yao

et al. 2024

Int J Equity Health

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Evaluation of the effect of DRG payment policy based on interrupted time series modeling: evidence from a tertiary hospital in Anhui Province

Mo,

Zhu,

Fang

et al. 2024

Health Res Policy Sys

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Background The payment methodology for diagnosis-related groups (DRG) has implications for both society and medical institutions. Our study aims to analyse the impact of the reform of the payment policy according to the DRG on the operation of a tertiary hospital in Anhui Province. Methods Monthly data were collected from April 2020 to September 2023 during the reform period for a tertiary hospital on nine types of operational indicators, including average length of stay (ALOS), number of discharges, number of outpatient visits, percentage of discharged patients undergoing level III or IV surgery, bed turnover rate, inpatient essential drug utilization rate, low-risk group mortality, outpatient subaverage cost and inpatient subaverage cost. The data were divided into two phases according to the time of DRG implementation: pre-reform (April 2020–December 2021) and post-reform (January 2022–September 2023), and the segmented regression model with interrupted time series data was used to analyse the changes in the trend of each type of indicator before and after the reform. Statistical analysis was performed using R software (4.3.1). Results After the implementation of the DRG, the number of discharges increased by 112 800 patients (95% confidence interval [CI] 31.125–194.484, P = 0.008), the bed turnover rate rose by 1.403% (95% CI 1.028–1.778, P = 0.022) and the percentage of discharged patients undergoing level III or IV surgery decreased by 0.098% (95% CI −0.181 to −0.015, P = 0.022). The low-risk group mortality decreased by 0.016% (95% CI −0.027 to −0.005, P = 0.007), and the inpatient subaverage cost decreased by 81.514 CNY (95% CI −121.782 to −41.245, P < 0.001). However, there were no significant differences in the trends of average length of stay, outpatient visits, inpatient essential drug utilization rate and outpatient subaverage cost after the DRG implementation. Conclusions The findings show that the DRG reform has positively impacted hospital functioning, including quality, safety, efficiency and costs. Although the average length of stay remained unchanged, there was an increase in discharged patients and outpatient visits, indicating hospitals adapted to the new payment model. The reduction in low-risk group mortality suggests improvements in patient safety and care quality. However, challenges remain, as evidenced by decreased surgical complexity and initial drops in bed turnover rates. While the DRG reform holds promise for enhancing healthcare efficiency and controlling costs, potential negative effects such as patient selection bias and coding changes need to be monitored. Future research should focus on the long-term effects of the DRG policy across different healthcare institutions.

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Impact on members and retail pharmacies of China's Urban Employee Basic Medical Insurance medicine purchasing reforms: Case studies in Wuhan

Xu,

Nicholas,

Maitland

et al. 2024

Preprint

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Background In 2023, local health authorities implemented prescription medicine purchases from retail pharmacies by urban employee basic medical insurance (UEBMI) members. Using case studies from Wuhan, we assess the impact of the 2023 medicine purchasing reform on the medicine buying behavior; evaluate the benefits of the changes to UEMBI members; and provide insights into China’s retail pharmacies’ business model. Methods Daily UEBMI claim data was collected at two Wuhan pharmacies from March 2022 to December 2023, including data on customer age, sex, employment state and claim type before and after the implementation of the 2023 policy. The impact of the new retail pharmacy purchasing policy on medicines purchasing behavior, such as the number of medicine purchasers, the total expenditure per capita, and the medical savings accounts expenditure per capita, were quantitatively evaluated using descriptive statistics and interrupted time series analysis (ITSA). Results The characteristics of medicine purchasers were not significantly affected by the new policy. Retired UEBMI members benefited more from allowing UEBMI funds for prescription purchases from retail pharmacies than currently employed UEBMI members. The number of UEBMI member medicine purchasers from retail pharmacies showed a significant upward trend, increasing the benefits to UEBMI members, without medicine over-use or risk of fraud. The benefit to members was measured by the absence of any significant upward per capita total expenditure trend and a significant decrease in the proportion of medicine expenditures from members personal medical savings accounts. Conclusions The 2023 reforms allowed UEBMI members to purchase medicine from retail pharmacies, providing medicine accessibility and affordability for members, especially retired members; did not trigger an increase in members’ medicine consumption; attenuated the over-use of hospital pharmacies; and transformed pharmacies’ business model away from a singular focus on price competition towards a combination of price competition and health services.

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Does a new case-based payment system promote the construction of the ordered health delivery system? Evidence from a pilot city in China

Cited by 3 publications

References 55 publications

The impact of an innovative payment method on medical expenditure, efficiency, and quality for inpatients with different types of medical insurance: evidence from a pilot city, China

The impact of an innovative payment method on medical expenditure, efficiency, and quality for inpatients with different types of medical insurance: evidence from a pilot city, China

Evaluation of the effect of DRG payment policy based on interrupted time series modeling: evidence from a tertiary hospital in Anhui Province

Impact on members and retail pharmacies of China's Urban Employee Basic Medical Insurance medicine purchasing reforms: Case studies in Wuhan

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