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Payment reform and changes in health care in China

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  • Gao, Chen
  • Xu, Fei
  • Liu, Gordon G.

Abstract

This paper is intended to assess the primary effects on cost, utilization and quality of care from payment reform of capitation and open enrollment in Changde city, Hunan Province of China. Open enrollment policy was introduced to deal with possible cream skimming associated with capitation. Based on the longitudinal Urban Resident Basic Medical Insurance (URBMI) Household Survey, this study analyses the URBMI data through a set of regression models. The original data included over five thousand inpatient admissions during the study period between 2008 and 2010. The study finds the payment reform to reduce its inpatient out-of-pocket cost by 19.7%, out-of-pocket ratio by 9.5%, and length of stay by 17.7%. However, the total inpatient cost, drug cost ratio, treatment effect, and patient satisfaction showed little difference between Fee-For-Service and capitation models. We conclude that the payment reform in Changde did not reduce overall inpatient expenditure, but it decreased the financial risk and length of stay of inpatient patients without compromising quality of care. The findings would contribute to the health care payment literatures from developing countries and open further research tracks on the ability of open enrollment to compensate for capitation drawbacks.

Suggested Citation

  • Gao, Chen & Xu, Fei & Liu, Gordon G., 2014. "Payment reform and changes in health care in China," Social Science & Medicine, Elsevier, vol. 111(C), pages 10-16.
    • Handle: RePEc:eee:socmed:v:111:y:2014:i:c:p:10-16
    DOI: 10.1016/j.socscimed.2014.03.035
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    References listed on IDEAS

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    1. Dickey, Barbara, 1997. "Assessing cost and utilization in managed mental health care in the United States," Health Policy, Elsevier, vol. 41(Supplemen), pages 163-174, September.
    2. Edward C. Norton & Courtney Harold Van Houtven & Richard C. Lindrooth & Sharon‐Lise T. Normand & Barbara Dickey, 2002. "Does prospective payment reduce inpatient length of stay?," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 377-387, July.
    3. Moreno-Serra, Rodrigo & Wagstaff, Adam, 2010. "System-wide impacts of hospital payment reforms: Evidence from Central and Eastern Europe and Central Asia," Journal of Health Economics, Elsevier, vol. 29(4), pages 585-602, July.
    4. Mark McClellan, 2011. "Reforming Payments to Healthcare Providers: The Key to Slowing Healthcare Cost Growth While Improving Quality?," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 69-92, Spring.
    5. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
    6. Karen Eggleston & Li Ling & Meng Qingyue & Magnus Lindelow & Adam Wagstaff, 2008. "Health service delivery in China: a literature review," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 149-165, February.
    7. Wanchuan Lin & Gordon G. Liu & Gang Chen, 2009. "The Urban Resident Basic Medical Insurance: a landmark reform towards universal coverage in China," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 83-96, July.
    8. Mills, Anne & Bennett, Sara & Siriwanarangsun, Porntep & Tangcharoensathien, Viroj, 2000. "The response of providers to capitation payment: a case-study from Thailand," Health Policy, Elsevier, vol. 51(3), pages 163-180, April.
    9. Pan, Jay & Liu, Gordon G. & Gao, Chen, 2013. "How does separating government regulatory and operational control of public hospitals matter to healthcare supply?," China Economic Review, Elsevier, vol. 27(C), pages 1-14.
    10. Kroneman, Madelon & Nagy, Julia, 2001. "Introducing DRG-based financing in Hungary: a study into the relationship between supply of hospital beds and use of these beds under changing institutional circumstances," Health Policy, Elsevier, vol. 55(1), pages 19-36, January.
    11. Winnie Yip & Karen Eggleston, 2001. "Provider payment reform in China: the case of hospital reimbursement in Hainan province," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 325-339, June.
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    4. Julie Shi & Yi Yao & Gordon Liu, 2018. "Modeling individual health care expenditures in China: Evidence to assist payment reform in public insurance," Health Economics, John Wiley & Sons, Ltd., vol. 27(12), pages 1945-1962, December.
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    7. Liu, Kai & Zhang, Qian & He, Alex Jingwei, 2021. "The impacts of multiple healthcare reforms on catastrophic health spending for poor households in China," Social Science & Medicine, Elsevier, vol. 285(C).

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