Miao Yudong, Yuan Xiangdong, Gu Jianqin, Zhang Liang, He Ruibo, Sandeep Sandeep, Wu Jian
a Department of General Medicine of Henan Provincial People's Hospital , Zhengzhou , China.
b School of Health Policy and Management , Nanjing Medical University , Nanjing , China.
J Med Econ. 2019 Mar;22(3):245-251. doi: 10.1080/13696998.2018.1558864. Epub 2019 Jan 17.
To construct a value-based healthcare system for rural Chinese hypertensive patients through an increasing outpatient care reimbursement ratio.
This comparative study sampled two similar counties, Dangyang County and Zhijiang County, in Hubei Province of China, as the intervention group and the control group, respectively. The Social Health Insurance Fund of the intervention group budgeted 600 yuan per capita per year to insured patients with third stage hypertension to cover their outpatient expenditures, while the outpatient expenditures of the control group were not covered by its Social Health Insurance Fund. The inpatient expenditure reimbursement policies in both groups were not adjusted during the study. Value improvement in this study was defined as reduction in medical costs and improvement in health outcomes within the pilot healthcare system. A propensity score matching model combined with a difference-in-differences model was used to estimate the changes in medical costs and health outcomes.
In total, 1,673 pairs of patients were enrolled into statistical analysis after the propensity score matching. The intervention increased per capita annual outpatient expenditure by 81.2 (+31.8%) yuan (p > .05), but decreased the per capita annual inpatient expenditure and total medical expenditure by 475.4 (-40.7%) yuan and 394.2 (-27.7%) yuan, respectively (p < .05). Accordingly, the per capita annual total medical expenditure reimbursement decreased by 192.3 (-28.5%) yuan (p < .05), and the per capita annual total out-of-pocket expenditure by 201.9 (-29.9%) yuan (p < .05). The diastolic blood pressure of the intervention group decreased significantly by 2.9 mmHg (p < .05), but no significant change was found in systolic blood pressure and prevalence of hypertension complications (p > .05).
Increasing the outpatient expenditures, the reimbursement ratio was beneficial to the value of the healthcare system for hypertensive patients. Outpatient care for patients with chronic diseases should be prioritized for rural China and healthcare settings with inadequate health insurance funds.
通过提高门诊护理报销比例，为中国农村高血压患者构建基于价值的医疗体系。
本比较研究选取中国湖北省两个相似的县，当阳县和枝江县，分别作为干预组和对照组。干预组的社会医疗保险基金每年为患有三期高血压的参保患者人均预算600元，以支付其门诊费用，而对照组的门诊费用不由其社会医疗保险基金支付。研究期间，两组的住院费用报销政策均未调整。本研究中的价值提升定义为试点医疗体系内医疗成本的降低和健康结果的改善。采用倾向得分匹配模型结合差分模型来估计医疗成本和健康结果的变化。
经过倾向得分匹配后，共有1673对患者纳入统计分析。干预使人均年度门诊支出增加了81.2（+31.8%）元（p＞0.05），但人均年度住院支出和总医疗支出分别减少了475.4（-40.7%）元和394.2（-27.7%）元（p＜0.05）。相应地，人均年度总医疗支出报销减少了192.3（-28.5%）元（p＜0.05），人均年度总自付支出减少了201.9（-29.9%）元（p＜0.05）。干预组的舒张压显著降低了2.9 mmHg（p＜0.05），但收缩压和高血压并发症患病率未发现显著变化（p＞0.05）。
提高门诊支出报销比例有利于高血压患者医疗体系的价值。对于中国农村地区以及医疗保险资金不足的医疗机构，应优先考虑慢性病患者的门诊护理。
