title: Effects of Public Hospital Reform on Inpatient Expenditures in Rural China.
abstract: Public hospital reform is one priority area in the healthcare system reform that China launched in 2009. The Chinese government invested over $10bn for pilot projects in public hospital reform in rural China. However, little evidence exists on their effects. Using a quasi-natural experiment design, we evaluated the effects of a public hospital pilot project in Hubei province on inpatient spending. We obtained inpatient claims data from 1/1/2011 through 6/30/2013 for enrollees in the New Cooperative Medical Scheme in two counties: Danjiangkou, one of the pilot counties selected for reform in September 2012, and Laohekou, a similar, adjacent county serving as the control group. Using a difference-in-differences approach with propensity score weighting, we found that total inpatient spending increased ¥1160 (95% CI 1155-1166), out-of-pocket spending increased ¥385 (95% CI 382-389), length of stay increased 0.51 days (95% CI 0.50-0.52), but inpatient medication spending decreased ¥147 (95% CI 145-150), post-policy in Danjiangkou, relative to the control group. The overall reimbursement rate increased by 5.7 percentage points. One of the goals of the recent public hospital reform is to make inpatient services affordable to patients. We found that although patients spent less on inpatient medications, total out-of-pocket spending increased considerably after reform. Copyright © 2016 John Wiley & Sons, Ltd.
authors: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Yuting
authors: Y
authors: Zhang
authors: Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Qianheng
authors: Q
authors: Ma
authors: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.|Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China.
authors: Yingchun
authors: Y
authors: Chen
authors: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.|Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China.
authors: Hongxia
authors: H
authors: Gao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D005260:Female; D018166:Health Care Reform / Q000379:methods*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012424:Rural Population
keywords: China; healthcare expenditures; public hospital reform