title: Effect of the medical insurance on the quality of care for Chinese patients with chronic heart failure.
abstract: OBJECTIVE
  To assess the effect of medical insurance on the quality of care for patients with chronic heart failure (CHF).
  
  
  METHODS
  Seven quality indicators were used to assess the association between medical insurance and quality of care. Statistical analyses were conducted using multilevel logistic models for the total population and the subpopulation stratified by sex and age.
  
  
  METHODS
  In total, 1862 CHF patients who were admitted in 20 tertiary hospitals between 1 January 2009 and 31 October 2010.
  
  
  RESULTS
  Of 1862 patients, 53.8% patients had basic medical insurance and 26.9% patients paid the hospital costs by themselves. After adjusting for confounding factors, patients with New Rural Cooperative Medical Scheme (NRCMS) were more likely to receive warfarin (odds ratios [OR], 3.89; 95% confidence interval [CI], 1.08-13.99; P = 0.038), but less likely to receive aldosterone receptor antagonist (OR, 0.21; 95% CI, 0.08-0.56; P = 0.002) than patients without any medical insurance. Urban Employee Basic Medical Insurance (UEBMI) and NRCMS were associated with more use of discharge instructions ([OR, 3.54; 95% CI, 2.44-5.13; P < 0.001] and [OR, 2.09; 95% CI, 1.21-3.62; P = 0.009], respectively). After stratified by sex, male patients with UEBMI were more likely to receive the evaluation of left ventricular function than male patients without any medical insurance (OR, 1.78; 95% CI, 1.06-2.98; P = 0.029).
  
  
  CONCLUSIONS
  UEBMI and NRCMS could increase the adherence to quality indicators of CHF to some extent. Improving the medical insurance system is expected to achieve equality in medical security and improve the quality of care for CHF patients.
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, 150081, PR China.|Department of Epidemiology and Health Statistics, Public Health College, Fujian Medical University, 1 Xueyuan Road, Fuzhou City, Fujian Province, 350108, PR China.
authors.forename: Rong
authors.initials: R
authors.lastname: Fu
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, 150081, PR China.
authors.forename: Han
authors.initials: H
authors.lastname: Bao
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, 150081, PR China.
authors.forename: Shaofei
authors.initials: S
authors.lastname: Su
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, 150081, PR China.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, 150081, PR China.
authors.forename: Meiqi
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, 150081, PR China.
authors.forename: Meina
authors.initials: M
authors.lastname: Liu
mesh_terms: D002681:China; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage; D010351:Patient Discharge; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D016277:Ventricular Function, Left
chemical_list: D000451:Mineralocorticoid Receptor Antagonists
keywords: China; chronic heart failure; health service utilization; medical insurance; quality of care