IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v15y2018i12p2839-d190189.html
   My bibliography  Save this article

Medical Service Quality, Efficiency and Cost Control Effectiveness of Upgraded Case Payment in Rural China: A Retrospective Study

Author

Listed:
  • Ruibo He

    (School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China)

  • Ting Ye

    (School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China)

  • Jing Wang

    (School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China)

  • Yan Zhang

    (School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China)

  • Zhong Li

    (School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China)

  • Yadong Niu

    (School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China)

  • Liang Zhang

    (School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China)

Abstract

Background: As the principal means of reimbursing medical institutions, the effects of case payment still need to be evaluated due to special environments and short exploration periods, especially in rural China. Methods: Xi County was chosen as the intervention group, with 36,104, 48,316, and 59,087 inpatients from the years 2011 to 2013, respectively. Huaibin County acted as the control group, with 33,073, 48,122, and 51,325 inpatients, respectively, from the same period. The inpatients’ information was collected from local insurance agencies. After controlling for age, gender, institution level, season fixed effects, disease severity, and compensation type, the generalised additive models (GAMs) and difference-in-differences approach (DID) were used to measure the changing trends and policy net effects from two levels (the whole county level and each institution level) and three dimensions (cost, quality and efficiency). Results: At the whole-county level, the cost-related indicators of the intervention group showed downward trends compared to the control group. Total spending, reimbursement fee and out-of-pocket expense declined by ¥346.59 ( p < 0.001), ¥105.39 ( p < 0.001) and ¥241.2 ( p < 0.001), respectively (the symbol ¥ represents Chinese yuan). Actual compensation ratio, length of stay, and readmission rates exhibited ascending trends, with increases of 7% ( p < 0.001), 2.18 days ( p < 0.001), and 1.5% ( p < 0.001), respectively. The intervention group at county level hospital had greater length of stay reduction (¥792.97 p < 0.001) and readmission rate growth (3.3% p < 0.001) and lower reimbursement fee reduction (¥150.16 p < 0.001) and length of stay growth (1.24 days p < 0.001) than those at the township level. Conclusions: Upgraded case payment is more reasonable and suitable for rural areas than simple quota payment or cap payment. It has successfully curbed the growth of medical expenses, improved the efficiency of medical insurance fund utilisation, and alleviated patients’ economic burden of disease. However, no positive effects on service quality and efficiency were observed. The increase in readmission rate and potential hidden dangers for primary health care institutions should be given attention.

Suggested Citation

  • Ruibo He & Ting Ye & Jing Wang & Yan Zhang & Zhong Li & Yadong Niu & Liang Zhang, 2018. "Medical Service Quality, Efficiency and Cost Control Effectiveness of Upgraded Case Payment in Rural China: A Retrospective Study," IJERPH, MDPI, vol. 15(12), pages 1-13, December.
    • Handle: RePEc:gam:jijerp:v:15:y:2018:i:12:p:2839-:d:190189
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/15/12/2839/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/15/12/2839/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Alberto Abadie, 2005. "Semiparametric Difference-in-Differences Estimators," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 72(1), pages 1-19.
    2. Yuting Zhang & Qianheng Ma & Yingchun Chen & Hongxia Gao, 2017. "Effects of Public Hospital Reform on Inpatient Expenditures in Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 26(4), pages 421-430, April.
    3. Lang, Hui-Chu & Chi, Chunhuei & Liu, Chi-Ming, 2004. "Impact of the case payment reimbursement method on the utilization and costs of laparoscopic cholecystectomy," Health Policy, Elsevier, vol. 67(2), pages 195-206, February.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Wanchun Xu & Zijing Pan & Zhong Li & Shan Lu & Liang Zhang, 2020. "Job Burnout Among Primary Healthcare Workers in Rural China: A Multilevel Analysis," IJERPH, MDPI, vol. 17(3), pages 1-18, January.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Alexandre Belloni & Victor Chernozhukov & Denis Chetverikov & Christian Hansen & Kengo Kato, 2018. "High-dimensional econometrics and regularized GMM," CeMMAP working papers CWP35/18, Centre for Microdata Methods and Practice, Institute for Fiscal Studies.
    2. Matias Busso & Patrick Kline, 2008. "Do Local Economic Development Programs Work? Evidence from the Federal Empowerment Zone Program," Cowles Foundation Discussion Papers 1639, Cowles Foundation for Research in Economics, Yale University.
    3. Sant’Anna, Pedro H.C. & Zhao, Jun, 2020. "Doubly robust difference-in-differences estimators," Journal of Econometrics, Elsevier, vol. 219(1), pages 101-122.
    4. Trojanek, Radoslaw & Huderek-Glapska, Sonia, 2018. "Measuring the noise cost of aviation – The association between the Limited Use Area around Warsaw Chopin Airport and property values," Journal of Air Transport Management, Elsevier, vol. 67(C), pages 103-114.
    5. Picarelli, Nathalie, 2016. "Who really benefits from export processing zones? Evidence from Nicaraguan municipalities," Labour Economics, Elsevier, vol. 41(C), pages 318-332.
    6. Christophe Loussouarn & Carine Franc & Yann Videau & Julien Mousquès, 2021. "Can General Practitioners Be More Productive? The Impact of Teamwork and Cooperation with Nurses on GP Activities," Health Economics, John Wiley & Sons, Ltd., vol. 30(3), pages 680-698, March.
    7. Malerba, Daniele, 2020. "Poverty alleviation and local environmental degradation: An empirical analysis in Colombia," World Development, Elsevier, vol. 127(C).
    8. Mansur, Erin T, 2007. "Upstream Competition and Vertical Integration in Electricity Markets," Journal of Law and Economics, University of Chicago Press, vol. 50(1), pages 125-156, February.
    9. Melanie Arntz & Simon Lo & Ralf Wilke, 2014. "Bounds analysis of competing risks: a non-parametric evaluation of the effect of unemployment benefits on migration," Empirical Economics, Springer, vol. 46(1), pages 199-228, February.
    10. Francesco Vona & Giovanni Marin & Davide Consoli, 2019. "Measures, drivers and effects of green employment: evidence from US local labor markets, 2006–2014," Journal of Economic Geography, Oxford University Press, vol. 19(5), pages 1021-1048.
    11. Gnangnon, Sèna Kimm, 2023. "The Least developed countries' TRIPS Waiver and the Strength of Intellectual Property Protection," EconStor Preprints 271537, ZBW - Leibniz Information Centre for Economics.
    12. Asako Ohinata & Matteo Picchio, 2020. "Financial support for long-term elderly care and household saving behaviour," Oxford Economic Papers, Oxford University Press, vol. 72(1), pages 247-268.
    13. Pablo Lavado & Gonzalo Rivera, 2016. "Identifying Treatment Effects with Data Combination and Unobserved Heterogeneity," Working Papers 79, Peruvian Economic Association.
    14. Haiyang Lu & Peng Nie & Alfonso Sousa-Poza, 2021. "The Effect of Parental Educational Expectations on Adolescent Subjective Well-Being and the Moderating Role of Perceived Academic Pressure: Longitudinal Evidence for China," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 14(1), pages 117-137, February.
    15. Chen, Jing & Li, Rui, 2023. "Pay for elite private schools or pay for higher housing prices? Evidence from an exogenous policy shock," Journal of Housing Economics, Elsevier, vol. 60(C).
    16. Patrick Bennett, 2021. "The Work-To-School Transition: Job Displacement and Skill Upgrading among Young High School Dropouts," CESifo Working Paper Series 9417, CESifo.
    17. James Roumasset & Christopher Wada, 2012. "The Economics of Groundwater," Working Papers 201211, University of Hawaii at Manoa, Department of Economics.
    18. Chabé-Ferret, Sylvain, 2017. "Should We Combine Difference In Differences with Conditioning on Pre-Treatment Outcomes?," TSE Working Papers 17-824, Toulouse School of Economics (TSE).
    19. Callaway, Brantly & Li, Tong & Oka, Tatsushi, 2018. "Quantile treatment effects in difference in differences models under dependence restrictions and with only two time periods," Journal of Econometrics, Elsevier, vol. 206(2), pages 395-413.
    20. Fabio Méndez & Facundo Sepúlveda & Nieves Valdés, 2016. "Legalization and human capital accumulation," Journal of Population Economics, Springer;European Society for Population Economics, vol. 29(3), pages 721-756, July.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:15:y:2018:i:12:p:2839-:d:190189. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.