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A new charging scheme in an emergency department observation unit under Beijing's basic medical insurance

Xinhua He1, Li Gao2, Fei Teng1

  • 1Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.

Chinese Medical Journal
|October 1, 2014
PubMed

Insights

Beijing’s new medical insurance policy made it easier for patients to access hospital admissions from emergency department observation units. However, this policy led to longer stays, increased costs, and overcrowding in emergency departments.

Area of Science:

  • Health Policy
  • Medical Economics
  • Emergency Medicine

Background:

  • A new medical insurance policy (JRSYF(2010) No.255) was implemented in Beijing on January 1, 2011.
  • This policy allows medical expenses from emergency department (ED) observation unit stays to be reimbursed as hospital admissions.
  • The policy aimed to evaluate the impact of a new charging scheme on ED observation unit stays under Beijing's Basic Medical Insurance.

Purpose of the Study:

  • To assess the effects of Beijing's new medical insurance charging scheme on ED observation unit utilization.
  • To analyze changes in length of stay, patient volume, and medical costs post-policy implementation.
  • To evaluate the impact on patient demographics, specifically the elderly population.

Main Methods:

  • Retrospective analysis of patient data from ED observation units in 2010 (pre-policy) and 2012 (post-policy).
  • Key metrics analyzed included length of stay, number of patients observed (PO), and median medical costs.
  • Demographic data, including the proportion of elderly patients (≥ 60 years), were compared between the two periods.

Main Results:

  • Post-policy implementation (2012 vs. 2010), there were significant increases in length of stay (6 vs. 5 days), PO (2,257 vs. 1,783), and median medical costs (RMB 6,026 vs. 3,650).
  • The proportion of elderly patients (≥ 60 years) increased significantly (70.22% vs. 63.71%).
  • Admitted patients in ED observation units experienced longer stays (>15 days: 36.22% vs. 5.61%), higher costs (RMB 9,186 vs. 5,668), and were more frequently elderly (86.10% vs. 66.39%) compared to non-admitted patients.

Conclusions:

  • The new charging scheme facilitates easier access to inpatient admission from ED observation units, reducing patients' financial burden.
  • The policy has led to increased ED payments by the insurance system due to longer stays and higher patient volumes.
  • However, the policy contributes to slower turnover rates in ED observation units, potentially causing overcrowding and necessitating a balance of benefits and drawbacks.
Abstract

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