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Association between health insurance cost-sharing and choice of hospital tier for cardiovascular diseases in China: a prospective cohort study.
Levy, Muriel; Buckell, John; Clarke, Robert; Wu, Nina; Pei, Pei; Sun, Dianjianyi; Avery, Daniel; Zhang, Hua; Lv, Jun; Yu, Canqing; Li, Liming; Chen, Zhengming; Yip, Winnie; Chen, Yiping; Mihaylova, Borislava.
Afiliación
  • Levy M; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK.
  • Buckell J; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK.
  • Clarke R; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK.
  • Wu N; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK.
  • Pei P; Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, UK.
  • Sun D; School of Public Health, Capital Medical University, Beijing, China.
  • Avery D; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China.
  • Zhang H; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China.
  • Lv J; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China.
  • Yu C; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK.
  • Li L; NCDs Prevention and Control Department, Qingdao Centre for Disease Control and Prevention, Qingdao, China.
  • Chen Z; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China.
  • Yip W; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China.
  • Chen Y; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China.
  • Mihaylova B; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China.
Lancet Reg Health West Pac ; 45: 101020, 2024 Apr.
Article en En | MEDLINE | ID: mdl-38380231
ABSTRACT

Background:

Hospitals in China are classified into tiers (1, 2 or 3), with the largest (tier 3) having more equipment and specialist staff. Differential health insurance cost-sharing by hospital tier (lower deductibles and higher reimbursement rates in lower tiers) was introduced to reduce overcrowding in higher tier hospitals, promote use of lower tier hospitals, and limit escalating healthcare costs. However, little is known about the effects of differential cost-sharing in health insurance schemes on choice of hospital tiers.

Methods:

In a 9-year follow-up of a prospective study of 0.5 M adults from 10 areas in China, we examined the associations between differential health insurance cost-sharing and choice of hospital tiers for patients with a first hospitalisation for stroke or ischaemic heart disease (IHD) in 2009-2017. Analyses were performed separately in urban areas (stroke n = 20,302; IHD n = 19,283) and rural areas (stroke n = 21,130; IHD n = 17,890), using conditional logit models and adjusting for individual socioeconomic and health characteristics.

Findings:

About 64-68% of stroke and IHD cases in urban areas and 27-29% in rural areas chose tier 3 hospitals. In urban areas, higher reimbursement rates in each tier and lower tier 3 deductibles were associated with a greater likelihood of choosing their respective hospital tiers. In rural areas, the effects of cost-sharing were modest, suggesting a greater contribution of other factors. Higher socioeconomic status and greater disease severity were associated with a greater likelihood of seeking care in higher tier hospitals in urban and rural areas.

Interpretation:

Patient choice of hospital tiers for treatment of stroke and IHD in China was influenced by differential cost-sharing in urban areas, but not in rural areas. Further strategies are required to incentivise appropriate health seeking behaviour and promote more efficient hospital use.

Funding:

Wellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, China Ministry of Science and Technology, and National Natural Science Foundation of China.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Lancet Reg Health West Pac Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Lancet Reg Health West Pac Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido