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Effect of critical illness insurance on the medical expenditures of rural patients in China: an interrupted time series study for universal health insurance coverage

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 dat...

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Autores principales: Zhong, Zhengdong, Jiang, Junnan, Chen, Shanquan, Li, Lu, Xiang, Li
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871675/
https://www.ncbi.nlm.nih.gov/pubmed/33558343
http://dx.doi.org/10.1136/bmjopen-2020-036858
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author Zhong, Zhengdong
Jiang, Junnan
Chen, Shanquan
Li, Lu
Xiang, Li
author_facet Zhong, Zhengdong
Jiang, Junnan
Chen, Shanquan
Li, Lu
Xiang, Li
author_sort Zhong, Zhengdong
collection PubMed
description 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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spelling pubmed-78716752021-02-18 Effect of critical illness insurance on the medical expenditures of rural patients in China: an interrupted time series study for universal health insurance coverage Zhong, Zhengdong Jiang, Junnan Chen, Shanquan Li, Lu Xiang, Li BMJ Open Health Economics 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. BMJ Publishing Group 2021-02-08 /pmc/articles/PMC7871675/ /pubmed/33558343 http://dx.doi.org/10.1136/bmjopen-2020-036858 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Health Economics
Zhong, Zhengdong
Jiang, Junnan
Chen, Shanquan
Li, Lu
Xiang, Li
Effect of critical illness insurance on the medical expenditures of rural patients in China: an interrupted time series study for universal health insurance coverage
title Effect of critical illness insurance on the medical expenditures of rural patients in China: an interrupted time series study for universal health insurance coverage
title_full Effect of critical illness insurance on the medical expenditures of rural patients in China: an interrupted time series study for universal health insurance coverage
title_fullStr Effect of critical illness insurance on the medical expenditures of rural patients in China: an interrupted time series study for universal health insurance coverage
title_full_unstemmed Effect of critical illness insurance on the medical expenditures of rural patients in China: an interrupted time series study for universal health insurance coverage
title_short Effect of critical illness insurance on the medical expenditures of rural patients in China: an interrupted time series study for universal health insurance coverage
title_sort effect of critical illness insurance on the medical expenditures of rural patients in china: an interrupted time series study for universal health insurance coverage
topic Health Economics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871675/
https://www.ncbi.nlm.nih.gov/pubmed/33558343
http://dx.doi.org/10.1136/bmjopen-2020-036858
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