Effect of Critical Illness Insurance on the Medical Expenditures of Rural Patients in China: an Interrupted Time Series Study for Universal Health Insurance Coverage

Overview

Journal BMJ Open

Specialty General Medicine

Date 2021 Feb 9

PMID 33558343

Citations 3

Authors

Zhengdong Zhong

Junnan Jiang

Shanquan Chen

Lu Li

Li Xiang

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of this study is to determine if critical illness insurance (CII) promotes the universal health coverage to reduce out-of-pocket (OOP) medical expenditures and improve the effective reimbursement rate (ERR) in rural China.

Study Design: The 5-year monthly hospitalisation data, starting 2 years before the CII (ie, the 'intervention') began, were collected. Interrupted time series analysis models were used to evaluate the immediate and gradual effects of CII on OOP payment and ERR.

Setting: The study was conducted in Xiantao County, Hubei Province, China.

Participants: A total of 511 221 inpatients within 5 years were included in the analysis.

Results: In 2016, 100 288 patients received in-patient services, among which 4137 benefited from CII. After the implementation of CII, OOP expenses increased 32.2% (95% CI 24.8% to 39.5%, p<0.001). Compared with the preintervention periods, the trend changes decline at a rate of 0.7% per month after the implementation of CII. Similarly, a significant decrease was observed in log ERR after the intervention started. The rate of level change is 16% change (95% CI -20.0% to -12.1%, p<0.001).

Conclusion: CII did not decrease the OOP payments of rural inpatients in 2011-2016 periods. The limited extents of population coverage and financing resources can be attributed to these results. Therefore, the Chinese government must urgently raise the funds of CII and improve the CII policy reimbursement rate.

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References

Chi-Man Yip W, Hsiao W, Chen W, Hu S, Ma J, Maynard A . Early appraisal of China's huge and complex health-care reforms. Lancet. 2012; 379(9818):833-42. DOI: 10.1016/S0140-6736(11)61880-1. View

Meng Q, Fang H, Liu X, Yuan B, Xu J . Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet. 2015; 386(10002):1484-92. DOI: 10.1016/S0140-6736(15)00342-6. View

Li Y, Wu Q, Xu L, Legge D, Hao Y, Gao L . Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance. Bull World Health Organ. 2012; 90(9):664-71. PMC: 3442391. DOI: 10.2471/BLT.12.102178. View

Ye C, Duan S, Wu Y, Hu H, Liu X, You H . A preliminary analysis of the effect of the new rural cooperative medical scheme on inpatient care at a county hospital. BMC Health Serv Res. 2013; 13:519. PMC: 3867426. DOI: 10.1186/1472-6963-13-519. View

Meng Q, Xu L, Zhang Y, Qian J, Cai M, Xin Y . Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study. Lancet. 2012; 379(9818):805-14. DOI: 10.1016/S0140-6736(12)60278-5. View

Evans D, Etienne C . Health systems financing and the path to universal coverage. Bull World Health Organ. 2010; 88(6):402. PMC: 2878164. DOI: 10.2471/BLT.10.078741. View

Beard E, Marsden J, Brown J, Tombor I, Stapleton J, Michie S . Understanding and using time series analyses in addiction research. Addiction. 2019; 114(10):1866-1884. DOI: 10.1111/add.14643. View

Cheng L, Liu H, Zhang Y, Shen K, Zeng Y . The impact of health insurance on health outcomes and spending of the elderly: evidence from China's New Cooperative Medical Scheme. Health Econ. 2014; 24(6):672-91. PMC: 4790431. DOI: 10.1002/hec.3053. View

Jiang J, Chen S, Xin Y, Wang X, Zeng L, Zhong Z . Does the critical illness insurance reduce patients' financial burden and benefit the poor more: a comprehensive evaluation in rural area of China. J Med Econ. 2019; 22(5):455-463. DOI: 10.1080/13696998.2019.1581620. View

10.

Gillings D, Makuc D, Siegel E . Analysis of interrupted time series mortality trends: an example to evaluate regionalized perinatal care. Am J Public Health. 1981; 71(1):38-46. PMC: 1619708. DOI: 10.2105/ajph.71.1.38. View

11.

Yi H, Zhang L, Singer K, Rozelle S, Atlas S . Health insurance and catastrophic illness: a report on the New Cooperative Medical System in rural China. Health Econ. 2009; 18 Suppl 2:S119-27. DOI: 10.1002/hec.1510. View

12.

Ma J, Xu J, Zhang Z, Wang J . New cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural China. Int J Equity Health. 2016; 15:72. PMC: 4855492. DOI: 10.1186/s12939-016-0361-5. View

13.

Xu K, Evans D, Carrin G, Aguilar-Rivera A, Musgrove P, Evans T . Protecting households from catastrophic health spending. Health Aff (Millwood). 2007; 26(4):972-83. DOI: 10.1377/hlthaff.26.4.972. View

14.

Petrou P . An Interrupted Time-Series Analysis to Assess Impact of Introduction of Co-Payment on Emergency Room Visits in Cyprus. Appl Health Econ Health Policy. 2015; 13(5):515-23. DOI: 10.1007/s40258-015-0169-2. View

15.

You X, Kobayashi Y . The new cooperative medical scheme in China. Health Policy. 2009; 91(1):1-9. DOI: 10.1016/j.healthpol.2008.11.012. View

16.

Bhaskaran K, Gasparrini A, Hajat S, Smeeth L, Armstrong B . Time series regression studies in environmental epidemiology. Int J Epidemiol. 2013; 42(4):1187-95. PMC: 3780998. DOI: 10.1093/ije/dyt092. View

17.

Xiang L, Pan Y, Hou S, Zhang H, Sato K, Li Q . The impact of the new cooperative medical scheme on financial burden of tuberculosis patients: evidence from six counties in China. Infect Dis Poverty. 2016; 5:8. PMC: 4730613. DOI: 10.1186/s40249-015-0094-5. View

18.

Carrin G, Evans D, Xu K . Designing health financing policy towards universal coverage. Bull World Health Organ. 2007; 85(9):652. PMC: 2636413. DOI: 10.2471/blt.07.046664. View

19.

Zhang F, Wagner A, Soumerai S, Ross-Degnan D . Methods for estimating confidence intervals in interrupted time series analyses of health interventions. J Clin Epidemiol. 2008; 62(2):143-8. PMC: 3828652. DOI: 10.1016/j.jclinepi.2008.08.007. View

20.

Wagner A, Soumerai S, Zhang F, Ross-Degnan D . Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002; 27(4):299-309. DOI: 10.1046/j.1365-2710.2002.00430.x. View