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Managing Urban Stroke Health Expenditures in China: Role of Payment Method and Hospital Level
Yong Yang1,2, Xiaowei Man2,3, Zhe Yu4,2
1Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China.
Insights
Capitation payments offer the most cost savings for China's healthcare system and patients. This payment method resulted in the lowest hospital costs and out-of-pocket expenses for both outpatients and inpatients in various hospital settings.
Area of Science:
- Health Economics
- Public Health Policy
- Healthcare Management
Background:
- Stroke is a major public health concern in China, leading to significant financial burdens.
- Understanding the impact of different healthcare payment methods on costs is crucial for policy development.
Purpose of the Study:
- To evaluate which healthcare payment method minimizes hospital costs for China's system.
- To determine which payment method offers the lowest out-of-pocket (OOP) expenses for insured patients.
Main Methods:
- A 4-year cross-sectional study utilizing a 5% random sample of urban health insurance claims from the CHIRA database.
- Descriptive analysis and estimation using a generalized linear model (GLM) with a gamma distribution and log link.
Main Results:
- Capitation payments yielded the lowest hospital costs and OOP expenses for outpatients in primary hospitals.
- Fee-for-service (FFS) showed the lowest OOP expenses for secondary and tertiary hospital outpatients.
- Capitation payments were most cost-effective for inpatients across secondary and tertiary hospitals, reducing both total costs and OOP expenses.
Conclusions:
- Capitation payment is the most economical method for outpatients in primary hospitals and inpatients in secondary/tertiary hospitals.
- Policymakers should prioritize payment methods that balance low hospital costs and low patient OOP expenses.
- When a payment method doesn't achieve both, prioritizing methods with lower patient OOP expenses is recommended.
Background:
Stroke is one of the leading public health issues in China and imposes a heavy financial burden on patients and the healthcare system. This study assess which payment method provides the lowest hospital costs for China's healthcare system and the lowest out-of-pocket (OOP) expense for insured patients.
Methods:
This is a 4-year cross-sectional study. From the China Health Insurance Research Association (CHIRA) database, a 5% random sample of urban health insurance claims was obtained. Descriptive analysis was conducted and a generalized linear model (GLM) with a gamma distribution and a log link was estimated.
Results:
For outpatients, capitation payment had the lowest hospital cost (RMB180.9/US$28.8) and lowest OOP expenses (RMB75.6/US$12.0) per patient visit in primary hospitals compared with fee-for-service (FFS) payments. The global budget (GB) displayed the lowest total hospital costs (RMB344.7/US$54.8) in secondary hospitals, and was 27.4% (95% CI=-0.32, -0.29) lower than FFS. FFS had the lowest OOP expenses (RMB123.4/US$19.6 vs. RMB151.8/US$24.1) in secondary and tertiary hospitals. For inpatients, FFS had the lowest total hospital costs (RMB5918.7/US$941.1) per visit and capitation payments had the lowest OOP expenses (RMB876.5/US$139.4, 40.1% lower than FFS, 95% CI=-0.58, -0.15) in primary hospitals. Capitation payment had both the lowest hospital costs (RMB7342.9/US$1167.5 vs. RMB17 711.7/US$2816.2) and the lowest OOP expenses (RMB1664.2/US$264.6 vs. RMB3276.3/US$520.9) for both secondary and tertiary hospitals.
Conclusion:
For outpatients in primary hospitals and inpatients in secondary and tertiary hospitals, the capitation payment was the most money-saving payment method delivering both the lowest OOP expenses for patients and the lowest hospital total costs for hospitals. We recommend that health policymakers prioritize the implementation of the payment method with the lowest OOP expenses when the payment method does not deliver both the lowest hospital costs for the health system and lowest OOP expenses for patients.
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