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Did China's hospital reforms improve curative care expenditures? Evidence from Beijing hospitals
Yan Jiang1, Zhaoran Han1, Stephen Nicholas2,3
1School of Management, Beijing University of Chinese Medicine, No.11 North 3rd Ring Road East, Chaoyang District, Beijing, China.
Insights
Beijing
Area of Science:
- Health economics
- Healthcare policy
- Public health
Background:
- Beijing implemented comprehensive healthcare reforms in 2017 (Reform 1) and 2019 (Reform 2).
- These reforms aimed to control curative care expenditure (CCE) and improve healthcare delivery.
- The study evaluates the impact of these reforms on CCE and related indicators.
Purpose of the Study:
- To assess the effectiveness of Beijing's 2017 and 2019 healthcare reforms.
- To analyze changes in curative care expenditure (CCE) and patient burden post-reforms.
- To evaluate the impact on Beijing's hierarchical medical system (HMS).
Main Methods:
- Utilized patient data from January 2016 to December 2019 from the Hospital Information System (HIS).
- Employed multistage stratified cluster random sampling for data collection.
- Applied interrupted time series analysis (ITSA) to evaluate reform impacts on CCE and patient costs.
Main Results:
- Reforms did not curb the rising trend in CCE but lowered drug and consumable prices.
- Patient burden impact was mixed: outpatient costs rose in tertiary hospitals (Reform 1), while inpatient costs fell in some settings.
- Reforms had insignificant impact on the hierarchical medical system (HMS) and did not significantly shift patients to primary hospitals.
Conclusions:
- Reform outcomes partially aligned with objectives; CCE trend persisted despite price reductions.
- Significant pricing changes for medical services are needed to encourage primary hospital utilization.
- Enhancing primary hospital capacity and public awareness campaigns are recommended to strengthen the hierarchical medical system.
Introduction:
To assess whether the comprehensive reforms in 2017 (Reform 1) and 2019 (Reform 2) in Beijing have achieved the anticipated targets by analyzing the changes in curative care expenditure (CCE) and related indicators before and after the reforms.
Methods:
Due to the Covid-19 pandemic, data are not comparable for the period after 2019, we obtained records of patients from the Hospital Information System (HIS) between January 1, 2016 and December 31, 2019. The multistage stratified cluster random sampling was used to obtain sample data, and the System of Health Accounts 2011 was applied to account for the CCE of all hospitals in Beijing. We used an interrupted time series analysis (ITSA) to compare the changes in levels and trends before and after the reforms.
Results:
Overall, the reforms failed to impact the rising trend in CCE, but successfully lowered the level of drug and consumable prices in all hospitals and optimized the hospital revenue structure. The reforms' impact on patient burden was also mixed. For Reform 1, outpatient costs rose in tertiary hospitals, fell for inpatients in tertiary and secondary hospitals, and exhibited no change in all other hospitals. In terms of the trend, Reform 1 saw a fall in patient burden except for a rise inpatients in tertiary and primary hospitals. For Reform 2, the level of total expenditures per outpatient visit fell in primary hospitals, rose per inpatient bed day in secondary hospitals and had no change in all other hospitals. The impact of reforms on Beijing's hierarchical medical system (HMS) was not significant.
Conclusion:
The reform outcomes were only partially in line with the reforms' aims. While echoing the call for more resources for primary hospitals, only major patient medical service pricing changes would shift patients away from tertiary and secondary hospitals towards primary hospitals. We suggest that several measures be taken to enhance the service capacity of primary hospitals and that an advertising campaign be launched to inform and encourage patients to use primary hospitals as gatekeepers.
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