Cui Yueying, Wang Xi, Cheng Jiu, Wang Yifei, Yang Huimin, Feng Ruihua
Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
School of Government, Beijing Normal University, Beijing, China.
Front Public Health. 2025 Jul 2;13:1609842. doi: 10.3389/fpubh.2025.1609842. eCollection 2025.
The health insurance deregulation policy aimed to enhance healthcare accessibility by eliminating intra-provincial administrative hurdles. However, its impact on hospitalization patterns of high-burden chronic conditions like ischemic heart disease (IHD) remains unexamined.
Interrupted time-series analysis (ITSA) was employed to evaluate weekly hospitalization visits and expenses for 8,522 IHD inpatients across three Hebei counties (January 2021-July 2023). Models assessed immediate and longitudinal changes post-policy, adjusting for autocorrelation and seasonal trends.
Policy implementation triggered an immediate 20.27 surge in weekly hospitalizations ( = 0.006), with sustained utilization unaffected (β = 0.17, = 0.619). Per-visit hospitalization expenses maintained pre-deregulation policy declining trends (-126.71 CNY/week pre-policy vs. -32.04 CNY/week post-policy), despite a non-significant instantaneously increase by 478.43 ( = 0.723) in the first week following the implementation of this policy. Additionally, the health insurance deregulation policy reversed the weekly trend of insurance reimbursement costs per visit from decreasing (-81.98 CNY/week) to increasing trajectories (1.95 CNY/week, = 0.004).
The health insurance deregulation policy successfully expanded IHD care access without exacerbating financial burdens, demonstrating that administrative simplification can coexist with cost containment under concurrent payment reforms.
医疗保险放松管制政策旨在消除省内行政障碍，以提高医疗服务的可及性。然而，其对缺血性心脏病（IHD）等高负担慢性病住院模式的影响仍未得到研究。
采用中断时间序列分析（ITSA）评估河北省三个县8522名IHD住院患者的每周住院就诊情况和费用（2021年1月至2023年7月）。模型评估了政策实施后的即时和长期变化，并对自相关和季节性趋势进行了调整。
政策实施后，每周住院人数立即激增20.27%（P = 0.006），持续利用率未受影响（β = 0.17，P = 0.619）。尽管在该政策实施后的第一周，每次就诊的住院费用瞬间增加了478.43元（P = 0.723），但仍保持了放松管制政策前的下降趋势（政策前为每周-126.71元，政策后为每周-32.04元）。此外，医疗保险放松管制政策扭转了每次就诊保险报销费用每周下降（-81.98元/周）的趋势，转为上升轨迹（1.95元/周，P = 0.004）。
医疗保险放松管制政策成功扩大了IHD护理的可及性，而没有加重经济负担，表明在同时进行支付改革的情况下，行政简化可以与成本控制并存。
