Tan Huawei, Zhang Xueyu, Peng Xinyi, Guo Dandan, Chen Yingchun
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Arch Public Health. 2024 Aug 26;82(1):136. doi: 10.1186/s13690-024-01378-2.
To assess the impact of vertical integration (VI) within County-Level Integrated Health Organisations (CIHOs) on the costs of primary care inpatients.
This study assessed Xishui, a national pilot county for CIHOs, using inpatient claims data. The treatment group comprised 10,118 inpatients from 5 vertically integrated township health centres (THCs), while the control group consisted of 21,165 inpatients from 19 non-vertically integrated THCs. The periods from July 2020 to December 2021 and January 2022 to December 2022 were defined as pre- and post-policy intervention, respectively. The primary outcome variables were total health expenditures (THS), out-of-pocket (OOP) expenditures, and the proportion of OOP expenditures. Propensity score matching was employed to align inpatient demographics and disease characteristics between the groups, followed by a difference-in-differences analysis to evaluate the outcomes.
VI significantly increased THS (β = 0.1337, p < 0.01) and OOP expenditures per case (β = 0.1661, p < 0.001), but the increase in the proportion of OOP expenditures per case was not significant (β = 0.0029, p > 0.05). For the basic medical insurance for urban and rural residents, THS per case (β = 0.1343, p < 0.01) and OOP expenditures (β = 0.1714, p < 0.001) significantly increased. For the basic medical insurance system for employees, THS per case also increased significantly (β = 0.1238, p < 0.01), but the change in OOP expenditure proportion per case was not significant (β = 0.1020, p > 0.05). The THS per case led by Xishui County People's Hospital, the leading county medical sub-centre (CMSC), significantly increased (β = 0.1753, p < 0.01), whereas the increase led by Xishui County Traditional Chinese Medicine Hospital was not significant (β = 0.0742, p > 0.05). Increases in OOP expenditures per case were significant in CMSCs led by the People's Hospital and the Traditional Chinese Medicine Hospital (β = 0.1782, p < 0.01 and β = 0.0757, p < 0.05, respectively).
VI significantly increased THS and OOP expenditures for primary care inpatients. However, VI could exacerbate economic disparities in disease burden across different insurance categories.
评估县级综合卫生组织（CIHOs）内部的垂直整合（VI）对初级保健住院患者费用的影响。
本研究利用住院报销数据对CIHOs全国试点县习水县进行评估。治疗组包括来自5个垂直整合乡镇卫生院（THCs）的10118名住院患者，而对照组由来自19个非垂直整合THCs的21165名住院患者组成。2020年7月至2021年12月以及2022年1月至2022年12月这两个时间段分别被定义为政策干预前和干预后。主要结局变量为总医疗支出（THS）、自付费用（OOP）支出以及OOP支出比例。采用倾向得分匹配法使两组间住院患者人口统计学特征和疾病特征相匹配，随后进行差分分析以评估结局。
垂直整合显著增加了THS（β = 0.1337，p < 0.01）以及每例患者的OOP支出（β = 0.1661，p < 0.001），但每例患者OOP支出比例的增加并不显著（β = 0.0029，p > 0.05）。对于城乡居民基本医疗保险，每例患者的THS（β = 0.1343，p < 0.01）和OOP支出（β = 0.1714，p < 0.001）显著增加。对于职工基本医疗保险制度，每例患者的THS也显著增加（β = 0.1238，p < 0.01），但每例患者OOP支出比例的变化并不显著（β = 0.1020，p > 0.05）。由县级主要医疗分中心（CMSC）习水县人民医院主导的每例患者THS显著增加（β = 0.1753，p < 0.01），而由习水县中医医院主导的增加并不显著（β = 0.0742，p > 0.05）。在人民医院和中医医院主导的CMSC中，每例患者的OOP支出增加显著（分别为β = 0.1782，p < 0.01和β = 0.0757，p < 0.05）。
垂直整合显著增加了初级保健住院患者的THS和OOP支出。然而，垂直整合可能会加剧不同保险类别间疾病负担的经济差距。
