Effect of the new maternity insurance scheme on medical expenditures for caesarean delivery in Wuxi, China: a retrospective pre/post-reform case study
Chun Chen1,2,Zhihong Cheng3,Ping Jiang3,Mei Sun2,Qi Zhang4(),Jun Lv2()
1. School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China 2. Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China 3. Affiliated Hospital, Jiangnan University, Wuxi 214062, China 4. School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA
Aiming to control rising medical expenditures and help improve China’s healthcare systems, this study examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitals’ C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China (2004–2013), and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform. We also used paired sample t-tests and linear regression models to compare the mean medical expenditures between insured and uninsured women undergoing caesarean delivery during the post-reform period. After the scheme’s implementation, medical expenditures for caesarean deliveries declined and the medical expenditures of women covered by the scheme were significantly lower than those of uninsured patients. These findings indicated the scheme’s effectiveness in minimizing caesarean delivery expenditures. The cap-based medical insurance scheme with shared financial interest between insurance and healthcare providers would likely steer healthcare providers’ behaviors in a more cost-effective direction.
. [J]. Frontiers of Medicine, 2016, 10(4): 473-480.
Chun Chen,Zhihong Cheng,Ping Jiang,Mei Sun,Qi Zhang,Jun Lv. Effect of the new maternity insurance scheme on medical expenditures for caesarean delivery in Wuxi, China: a retrospective pre/post-reform case study. Front. Med., 2016, 10(4): 473-480.
Patients’ cap: reimbursement per delivering woman CNY 2300 (2001–2004) and CNY3000 (2005–2008)
Hospital’s cap (using tertiary-level hospitals and C-sections as an example): reimbursement to the hospital per C-section CNY 5300 (2009.01–2010.09), CNY5400 (2010.10–2011.12), and CNY 6100 (2012.01–2013.12)
Reimburse the same fixed amount cost to patients based on a fixed-fee reimbursement scheme regardless if the actual medical expenditure of the patients is above or below the cap
If the total cost is above the cap, insurance reimburses the cost to the hospital up to the total monthly cap, i.e., per capita cap Number of patients whose total cost is above the cap
If the total cost is below the cap, insurance reimburses the cost to the hospital directly every month
MIS only provided indirect and weak incentives for hospitals to provide cost-effective medical services.
The economic incentives of NMIS: if the total cost is below the total cap at the end of the year: from 2009 to 2011, 60% of the total reimbursement balance of insured deliveries between the total cap and the actual reimbursed amount was distributed by Wuxi’s insurance bureau to the hospitals as a cash rebate for their positive performance on cost control; since 2012, the rewards have been changed from cash rebate to budget reimbursement, which can only be used in the following year
Chen C, Dong W, Shen JJ, Cochran C, Wang Y, Hao M. Is the prescribing behavior of Chinese physicians driven by financial incentives? Soc Sci Med 2014; 120: 40–48
https://doi.org/10.1016/j.socscimed.2014.05.033
pmid: 25218152
3
Grant D. Physician financial incentives and cesarean delivery: new conclusions from the healthcare cost and utilization project. J Health Econ 2009; 28(1): 244–250
https://doi.org/10.1016/j.jhealeco.2008.09.005
pmid: 19027184
4
Tsai YW, Hu TW. National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan. Am J Public Health 2002; 92(9): 1514–1517
https://doi.org/10.2105/AJPH.92.9.1514
pmid: 12197985
5
Río I, Castelló A, Barona C, Jané M, Más R, Rebagliato M, Bosch S, Martínez E, Bolúmar F. Caesarean section rates in immigrant and native women in Spain: the importance of geographical origin and type of hospital for delivery. Eur J Public Health 2010; 20(5): 524–529
https://doi.org/10.1093/eurpub/ckq067
pmid: 20522515
6
Adinma ED, Nwakoby BA, Adinma BD. Integrating maternal health services into a health insurance scheme: effect on healthcare delivery. Nig Q J Hosp Med 2010; 20(2): 86–93
https://doi.org/10.4314/nqjhm.v20i2.58041
pmid: 21243858
7
Criel B, Van der Stuyft P, Van Lerberghe W. The Bwamanda hospital insurance scheme: effective for whom? A study of its impact on hospital utilization patterns. Soc Sci Med 1999; 48(7): 897–911
https://doi.org/10.1016/S0277-9536(98)00391-8
pmid: 10192557
8
Mensah J, Oppong JR, Schmidt CM. Ghana’s National Health Insurance Scheme in the context of the health MDGs: an empirical evaluation using propensity score matching. Health Econ 2010; 19(S1 Suppl): 95–106
https://doi.org/10.1002/hec.1633
pmid: 20730999
9
Richard F, Witter S, de Brouwere V. Innovative approaches to reducing financial barriers to obstetric care in low-income countries. Am J Public Health 2010; 100(10): 1845–1852
https://doi.org/10.2105/AJPH.2009.179689
pmid: 20724689
Feldman R. The economics of provider payment reform: are accountable care organizations the answer? J Health Polit Policy Law 2015; 40(4): 745–760
https://doi.org/10.1215/03616878-3150038
pmid: 26124297
14
Wuxi Statistic Bureau. Wuxi Statistical Yearbook (Wuxi Tong Ji Nian Jian). Beijing: China Statistics Press, 2014 (in Chinese)
Ren Y. Community Health Service. Dalian: Liaoning Science and Technology Press, 2011
18
Wuxi Statistic Bureau. Wuxi Statistical Yearbook (Wuxi Tong Ji Nian Jian). Beijing: China Statistics Press, 2013 (in Chinese)
19
Wuxi Statistic Bureau. A Briefing on the Development of Wuxi’s Economy in 2013 (2013 Wuxi Guo Ming Jing Ji She Hui Fa Zhan Tong Ji Gong Bao). . Wuxi Statistic Bureau, 2014 (in Chinese)
Zhang P. Disscuss on the expense of cesarean delivery. China Pract Med (Zhongguo Shi Yong Yi Yao) 2010; 5: 257–258 (in Chinese)
22
Ma X, Qi L. Grey analysis of the causes of single disease hospitalization expenses increase in the hospital. Chin Health Econ (Zhongguo Wei Sheng Jing Ji) 2011; 30: 71 (in Chinese)
23
Guterman S, Davis K, Schoenbaum S, Shih A. Using Medicare payment policy to transform the health system: a framework for improving performance. Health Aff (Millwood) 2009; 28(2): w238–w250
https://doi.org/10.1377/hlthaff.28.2.w238
pmid: 19174386
