Health Insurance and Chronic Disease Control

Eggleston, Karen; Bundorf, M. Kate; Triyana, Margaret; Wang, Yan; Zhou, Sen

doi:10.1017/9781316691113.014

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…The NCMS may increase QALYs by lowering the risk of having hypertension [20,30] as the HRQL score in hypertensive people is meaningfully lower than that of normotensive people [31].…”

Section: Methodsmentioning

confidence: 99%

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The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China

Wu¹,

Deaton²,

Jiao³

et al. 2018

PLoS ONE

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ObjectiveThe New Rural Cooperative Medical Scheme (NCMS) is a universal healthcare coverage plan now covering over 98% of rural residents in China, first implemented in 2003. Rising costs in the face of modest gains in health and financial protections have raised questions about the cost-effectiveness of the NCMS.MethodsUsing the most recent estimates of the NCMS’s health and economic consequences from a comprehensive review of the literature, we conducted a cost-effectiveness analysis using a Markov model for a hypothetical cohort between ages 20 and 100. We then did one-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulations to explore whether the incremental cost-effectiveness ratio (ICER) falls below 37,059 international dollars [Int$], the willingness-to-pay (WTP) threshold of three times per capita GDP of China in 2013.FindingsThe ICER of the NCMS over the lifetime of an average 20-year-old rural resident in China was about Int$71,480 per quality-adjusted life year (QALY) gained (95% confidence interval: cost-saving, Int$845,659/QALY). There was less than a 33% chance that the system was cost-saving or met the WTP threshold. However, the NCMS did fall under the threshold when changes in the program costs, the risk of mortality and hypertension, and the likelihood of labor force participation were tested in one-way sensitivity analyses.ConclusionThe NCMS appears to be economically inefficient in its current form. Further cost-effectiveness analyses are warranted in designing insurance benefit packages to ensure that the NCMS fund goes toward health care that has a good value in improving survival and quality of life.

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“…The NCMS may increase QALYs by lowering the risk of having hypertension [20,30] as the HRQL score in hypertensive people is meaningfully lower than that of normotensive people [31].…”

Section: Methodsmentioning

confidence: 99%

“…The NCMS may reduce the probability of having measured hypertension [20,30], which could save medical costs associated with hypertension and related comorbidities. The average annual direct medical expense among hypertensive patients in rural China was estimated to be Int$392 (95% CI: Int$344, Int$441) in 2013 [34].…”

Section: Methodsmentioning

confidence: 99%

The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China

Wu¹,

Deaton²,

Jiao³

et al. 2018

PLoS ONE

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“…However, benefits have increased over time, varying across counties because local governments have discretion in such matters-within the broad guidelines set by the central government. 21,22 The Beijing NCMS claims data include information about all of Beijing's NCMS-insured population in 2008-14-that is, 2.4 million residents, of whom about 100,000 have been diagnosed with diabetes. The data set includes details about inpatient and outpatient utilization and associated health expenditures (both reimbursed and out-of-pocket).…”

Section: Study Data and Methodsmentioning

confidence: 99%

Avoidable Hospital Admissions From Diabetes Complications In Japan, Singapore, Hong Kong, And Communities Outside Beijing

et al. 2017

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Improving the quality of primary care may reduce avoidable hospital admissions. Avoidable admissions for conditions such as diabetes are used as a quality metric in the Health Care Quality Indicators of the Organization for Economic Cooperation and Development (OECD). Using the OECD indicators, we compared avoidable admission rates and spending for diabetes-related complications in Japan, Singapore, Hong Kong, and rural and peri-urban Beijing, China, in the period 2008-14. We found that spending on diabetes-related avoidable hospital admissions was substantial and increased from 2006 to 2014. Annual medical expenditures for people with an avoidable admission were six to twenty times those for people without an avoidable admission. In all of our study sites, when we controlled for severity, we found that people with more outpatient visits in a given year were less likely to experience an avoidable admission in the following year, which implies that primary care management of diabetes has the potential to improve quality and achieve cost savings. Effective policies to reduce avoidable admissions merit investigation.

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Mortality In Rural China Declined As Health Insurance Coverage Increased, But No Evidence The Two Are Linked

et al. 2017

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Health insurance holds the promise of improving population health and survival and protecting people from catastrophic health spending. Yet evidence from lower- and middle-income countries on the impact of health insurance is limited. We investigated whether insurance expansion reduced adult mortality in rural China, taking advantage of differences across Chinese counties in the timing of the introduction of the New Cooperative Medical Scheme (NCMS). We assembled and analyzed newly collected data on NCMS implementation, linked to data from the Chinese Center for Disease Control and Prevention on cause-specific, age-standardized death rates and variables specific to county-year combinations for seventy-two counties in the period 2004-12. While mortality rates declined among rural residents during this period, we found little evidence that the expansion of health insurance through the NCMS contributed to this decline. However, our relatively large standard errors leave open the possibility that the NCMS had effects on mortality that we could not detect. Moreover, mortality benefits might arise only after many years of accumulated coverage.

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Health Insurance and Chronic Disease Control

Cited by 3 publications

References 21 publications

The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China

The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China

Avoidable Hospital Admissions From Diabetes Complications In Japan, Singapore, Hong Kong, And Communities Outside Beijing

Mortality In Rural China Declined As Health Insurance Coverage Increased, But No Evidence The Two Are Linked

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