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Managing Urban Stroke Health Expenditures in China: Role of Payment Method and Hospital Level.

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机构： [1]Medical Device Regulatory Research and Evaluation Center, West ChinaHospital, Sichuan University, Chengdu, China [2]School of Management, BeijingUniversity of Chinese Medicine, Beijing, China [3]National Institute of TraditionalChinese Medicine Strategy and Development, Beijing University of ChineseMedicine, Beijing, China [4]Guang’anmen Hospital, China Academy of ChineseMedical Sciences, Beijing, China [5]Australian National Institute of Managementand Commerce, Sydney, NSW, Australia [6]Guangdong Institute for InternationalStrategies, Guangdong University of Foreign Studies, Guangzhou, China [7]School of Economics and School of Management, Tianjin Normal University,Tianjin, China [8]Newcastle Business School, University of Newcastle, Callaghan,NSW, Australia [9]University of Liverpool Management School, University ofLiverpool, Liverpool, UK [10]China Health Insurance Research Association,Beijing, China

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关键词： Payment Method Health Insurance Health Expenditure Out-of-Pocket Payment Stroke

摘要：

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.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.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.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.© 2022 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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出版当年[2021]版：

大类 | 3 区医学

小类 | 3 区卫生保健与服务 3 区卫生政策与服务

最新[2025]版：

大类 | 3 区医学

小类 | 3 区卫生保健与服务 3 区卫生政策与服务

第一作者：

第一作者机构： [1]Medical Device Regulatory Research and Evaluation Center, West ChinaHospital, Sichuan University, Chengdu, China [2]School of Management, BeijingUniversity of Chinese Medicine, Beijing, China

通讯作者：

通讯机构： [2]School of Management, BeijingUniversity of Chinese Medicine, Beijing, China [3]National Institute of TraditionalChinese Medicine Strategy and Development, Beijing University of ChineseMedicine, Beijing, China

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Managing Urban Stroke Health Expenditures in China: Role of Payment Method and Hospital Level.

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