title: Impacts of a new insurance benefit with capitated provider payment on healthcare utilization, expenditure and quality of medication prescribing in China.
abstract: OBJECTIVE
  To assess a new Chinese insurance benefit with capitated provider payment for common diseases in outpatients.
  
  
  METHODS
  Longitudinal health insurance claims data, health administrative data and primary care facility data were used to assess trajectories in outpatient visits, inpatient admissions, expenditure per common disease outpatient (CD/OP) visit and prescribing indicators over time. We conducted segmented regression analyses of interrupted time series data to measure changes in level and trend overtime, and cross-sectional comparisons against external standards.
  
  
  RESULTS
  The number of total outpatient visits at 46 primary care facilities (on the CD/OP benefit as of July 2012) increased by 46 895 visits/month (P = 0.004, 95% CI: 15 795-77 994); the average number of CD/OP visits reached 1.84/year/enrollee in 2012; monthly inpatient admissions dropped from 6.4 (2009) to 4.3 (2012) per 1000 enrollees; the median total expenditure per CD/OP visit dropped by CNY 15.40 (P = 0.16, 95% CI: -36.95~6.15); injectable use dropped by 7.38% (P = 0.03, 95% CI: -14.08%~-0.68%); antibiotic use was not improved.
  
  
  CONCLUSIONS
  Zhuhai's new CD/OP benefit with capitated provider payment has expanded access to primary care, which may have led to a reduction in expensive specialist inpatient services for CD/OP benefit enrollees. Cost awareness was likely raised, and rapidly growing expenditures were contained. Although having been partially improved, inappropriate prescribing of antibiotics and injectables was still prevalent. More explicit incentives and specific quality of care targets must be incorporated into the capitated provider payment to promote scientifically sound and cost-effective care and treatment.
authors.affiliation: Department of Nutrition, Food and Drug Safety, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, P.R.China.
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.affiliation: Zhuhai Health Insurance Research Association, Zhuhai, Guangdong, P.R.China.
authors.forename: Xiaotian
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Management, Beijing Normal University, Zhuhai, Guangdong, P.R.China.
authors.forename: Zou
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Anita K
authors.initials: AK
authors.lastname: Wagner
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.affiliation: Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Hans V
authors.initials: HV
authors.lastname: Hogerzeil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics; D002681:China; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000191:economics / Q000592:standards; D017048:Health Care Costs; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics*; D006760:Hospitalization; D006801:Humans; D007342:Insurance Benefits; D007348:Insurance, Health; D008137:Longitudinal Studies; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010818:Practice Patterns, Physicians' / Q000592:standards; D011320:Primary Health Care / Q000191:economics; D011787:Quality of Health Care; D012044:Regression Analysis; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Atención primaria; Pago al proveedor; benefit package; calidad de la prescripción médica; dépense; ensemble des bénéfices; expenditure; gasto; healthcare utilization; paiement au prestataire; paquete de beneficios; primary care; provider payment; quality of medication prescribing; qualité des prescriptions de médicaments; soins primaires; uso de atención sanitaria; utilisation des soins de santé