School of Public Health, Capital Medical University, Beijing, 100069, China.
BMC Public Health. 2023 Nov 10;23(1):2224. doi: 10.1186/s12889-023-17161-x.
Medical costs have been rising rapidly in recent years, and China is controlling medical costs from the perspective of health insurance payments.
To explore the impact of the capitation prepayment method on medical expenses and health service utilization of coronary heart disease (CHD) patients, which provides a scientific basis for further improvement of the payment approach.
The diagnosis records of visits for CHD in the database from 2014 to 2016 (April to December each year) were selected, and two townships were randomly selected as the pilot and control groups. Propensity score matching (PSM) and difference-in-difference (DID) model were used to assess changes in outpatient and inpatient expenses and health service utilization among CHD patients after the implementation of the capitation prepayment policy.
There were eventually 3,900 outpatients and 664 inpatients enrolled in this study after PSM. The DID model showed that in the first year of implementing the reform, total outpatient expenses decreased by CNY 13.953, drug expenses decreased by CNY 11.289, as well as Medicare payments decreased by CNY 8.707 in the pilot group compared to the control group. In the second year of implementing the reform, compared with the control group, the pilot group had a reduction of CNY 3.123 in other expenses, and a reduction of CNY 6.841 in Medicare payments. There was no significant change in inpatient expenses in the pilot group compared to the control group, but there was an increase of 0.829 visits to rural medical institutions, and an increase of 0.750 visits within the county for inpatients.
The capitation prepayment method has been effective in controlling the outpatient expenses of CHD patients, as well as improving the medical service capacity of medical institutions within the Medical Community, and increasing the rate of inside county visits for inpatients.
近年来，医疗费用迅速上涨，中国从医疗保险支付的角度控制医疗费用。
探讨人头付费预付制对冠心病（CHD）患者医疗费用和卫生服务利用的影响，为进一步完善支付方式提供科学依据。
从数据库中选取 2014 年至 2016 年（每年 4 月至 12 月）的 CHD 就诊记录，随机抽取两个乡镇作为试点组和对照组。采用倾向评分匹配（PSM）和双重差分（DID）模型评估人头付费预付政策实施后 CHD 患者门诊和住院费用及卫生服务利用的变化。
PSM 后最终纳入 3900 名门诊患者和 664 名住院患者。DID 模型显示，改革实施的第一年，试点组总门诊费用减少了 13.953 元，药品费用减少了 11.289 元，医疗保险支出减少了 8.707 元，而对照组则有所增加。改革实施的第二年，与对照组相比，试点组其他费用减少了 3.123 元，医疗保险支出减少了 6.841 元。试点组与对照组相比，住院费用没有明显变化，但农村医疗机构的就诊次数增加了 0.829 次，县内就诊次数增加了 0.750 次。
人头付费预付制在控制 CHD 患者门诊费用方面是有效的，同时也提高了医疗社区内医疗机构的医疗服务能力，并增加了住院患者的县内就诊率。
