Meng Zhaolin, Zhu Min, Cai Yuanyi, Cao Xiaohong, Wu Huazhang
Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China.
BMC Health Serv Res. 2019 Apr 16;19(1):231. doi: 10.1186/s12913-019-4048-7.
Considering catastrophic health expenses in rural households with hospitalised members were unproportionally high, in 2013, China developed a model of systemic reform in Sanming by adjusting payment method, pharmaceutical system, and medical services price. The reform was expected to control the excessive growth of hospital expenditures by reducing inefficiency and waste in health system or shortening the length of stay. This study analyzed the systemic reform's impact on the financial burden and length of stay for the rural population in Sanming.
A total of 1,113,615 inpatient records for the rural population were extracted from the rural new cooperative medical scheme (NCMS) database in Sanming from 2007 to 2012 (before the reform) and from 2013 to 2016 (after the reform). We calculated the average growth rate of total inpatient expenditures and costs of different medical service categories (medications, diagnostic testing, physician services and therapeutic services) in these two periods. Generalized linear models (GLM) were employed to examine the effect of reform on out-of-pocket (OOP) expenditures and length of stay, controlling for some covariates. Furthermore, we controlled the fixed effects of the year and hospitals, and included cluster standard errors by hospital to assess the robustness of the findings in the GLM analysis.
The typical systemic reform decreased the average growth rate of total inpatient expenditures by 1.34%, compared with the period before the reform. The OOP expenditures as a share of total expenditures showed a downward trend after the reform (42.34% in 2013). Holding all else constant, individuals after the reform spent ¥308.42 less on OOP expenditures (p < 0.001) than they did before the reform. Moreover, length of stay had a decrease of 0.67 days after the reform (p < 0.001).
These results suggested that the typical systemic hospital reform of the Sanming model had some positive effects on cost control and reducing financial burden for the rural population. Considering the OOP expenditures as a share of total expenditures was still high, China still has a long way to go to improve the benefits rural people have enjoyed from the NCMS.
鉴于有住院成员的农村家庭灾难性医疗支出过高，2013年，中国通过调整支付方式、药品制度和医疗服务价格，在三明开展了一项系统性改革模式。预计该改革将通过减少卫生系统的低效率和浪费或缩短住院时间来控制医院支出的过度增长。本研究分析了该系统性改革对三明农村人口经济负担和住院时间的影响。
从三明市农村新型合作医疗（新农合）数据库中提取了2007年至2012年（改革前）以及2013年至2016年（改革后）共1,113,615份农村人口的住院记录。我们计算了这两个时期住院总支出以及不同医疗服务类别（药品、诊断检测、医生服务和治疗服务）费用的平均增长率。采用广义线性模型（GLM）来检验改革对自付费用支出和住院时间的影响，并控制一些协变量。此外，我们控制了年份和医院的固定效应，并纳入医院层面的聚类标准误以评估GLM分析结果的稳健性。
与改革前时期相比，典型的系统性改革使住院总支出的平均增长率降低了1.34%。改革后，自付费用支出占总支出的比例呈下降趋势（2013年为42.34%）。在其他条件不变的情况下，改革后的个体自付费用支出比改革前少308.42元（p < 0.001）。此外，改革后住院时间减少了0.67天（p < 0.001）。
这些结果表明，三明模式典型的系统性医院改革在成本控制和减轻农村人口经济负担方面有一些积极作用。鉴于自付费用支出占总支出的比例仍然较高，中国在提高农村居民从新农合中获得的福利方面仍有很长的路要走。
