title: A new charging scheme in an emergency department observation unit under Beijing's basic medical insurance.
abstract: BACKGROUND
  The new medical insurance policy (JRSYF(2010) No.255) was released by the Beijing Municipal Government and became effective on January 1, 2011. Medical expenses incurred during a stay in an emergency department (ED) observation unit can be reimbursed as a hospital admission. The aim of this study was to evaluate the impact of a new charging scheme during stays in ED observation unit under Beijing's Basic Medical Insurance.
  
  
  METHODS
  Data for those patients who had stayed in ED observation unit in 2010 (before the implementation of a new charging scheme) and 2012 (after the implementation of this policy) were retrospectively analyzed in terms of length of stay, patients who were observed (PO), and median medical costs.
  
  
  RESULTS
  After the implementation of a new charging scheme, compared with the year of 2010, in year of 2012, there were statistically significant longer lengths of stay at the observation unit (6 (4-9) vs. 5 (4-7) days; P < 0.001), more PO (2 257 vs. 1 783; P < 0.001), and more median medical costs (RMB 6 026 vs. 3 650 Yuan; P < 0.01). The proportion of elderly patients (≥ 60 years of age) in 2012 was larger than that in 2010 (70.22% vs. 63.71%; P < 0.01). It was performed on those patients who were admitted after the implementation of a new charging scheme. Compared with patients who were not admitted had stayed in ED observation units, the patients who were admitted had stayed in ED observation units that had a higher proportion for >15 days (36.22% vs. 5.61%; P < 0.01); they had higher median medical costs RMB (9 186 vs. 5 668 Yuan; P < 0.001) and they were more elderly (≥ 60 years of age) (86.10% vs. 66.39%; P < 0.01).
  
  
  CONCLUSIONS
  The new charging scheme under Beijing's Basic Medical Insurance allows patients to get access to inpatient admission more easily. It lowers patients' financial burden in ED observation unit. Since more people stay at ED observation unit, it increases ED payments by the insurance system. However, it slows the turnover rate of ED observation unit and causes overcrowding in ED. Hence, the advantages and disadvantages of the new policy are obvious.
authors.affiliation: Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Xinhua
authors.initials: X
authors.lastname: He
authors.affiliation: Medical Insurance Office, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Li
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Teng
authors.affiliation: Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Changhai
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Caijun
authors.initials: C
authors.lastname: Wu
authors.affiliation: Medical Insurance Office, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Li
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Chunsheng
authors.initials: C
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies