Impacts of unifying urban and rural residents’ medical insurance on the hospitalisation expenses of rural patients in eastern China: an interrupted time series analysis

OBJECTIVES: This study evaluated the impact of the Urban and Rural Residents’ Basic Medical Insurance scheme on hospitalisation expenses of rural patients in eastern China, which unified separate healthcare systems for urban and rural residents. DESIGN: Monthly hospitalisation data from municipal and county hospitals were collected from the local Medicare Fund Database, covering the period from January 2018 to December 2021. The unification of insurance between urban and rural patients was implemented at different times for county and municipal hospitals. An interrupted time series analysis was used to assess the immediate and gradual effects of the integrated policy on the total medical expenses, out-of-pocket (OOP) expenses and effective reimbursement rate (ERR) among rural patients. SETTING AND PARTICIPANTS: This study included 636 155 rural inpatients over 4 years in Xuzhou City, Jiangsu Province, China. RESULTS: In January 2020, the policy of urban and rural medical insurance was initially integrated in county hospitals, after which the ERR decreased at a monthly rate of 0.23% (p=0.002, 95% CI −0.37% to −0.09%) compared with the preintervention period. After the insurance systems were unified in municipal hospitals in January 2021, OOP expenses decreased by ¥63.54 (p=0.002, 95% CI −102.48 to −24.61) and the ERR increased at a monthly rate of 0.24% (p=0.029, 95% CI 0.03% to 0.045%). CONCLUSIONS: Our results suggest that the unification of urban and rural medical insurance systems was an effective intervention to reduce the financial burden of illness for rural inpatients, especially OOP expenses for hospitalisation in municipal hospitals.