Limits...
How do patients and providers react to different incentives in the Chinese multiple health security systems?

Zhang CY, Hashimoto H - Chin. Med. J. (2015)

Bottom Line: Patients under plans with lower copayment rates consumed significantly more medication compared with those under plans with higher copayment rates.Our results indicate that the different designs and monitoring of the health security systems in China cause opportunistic behavior by patients and providers.Reformation is necessary to reduce those incentives, and improve equity and efficiency in healthcare use.

View Article: PubMed Central - PubMed

Affiliation: Department of Health and Social Behavior, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, China.

ABSTRACT

Background: China has achieved universal health insurance coverage. This study examined how patients and hospitals react to the different designs of the plans and to monitoring of patients by the local authority in the Chinese multiple health security schemes.

Methods: The sample for analysis consisted of 1006 orthopedic inpatients who were admitted between January and December 2011 at a tertiary teaching hospital located in Beijing. We conducted general linear regression analyses to investigate whether medical expenditure and length of stay differed according to the different incentives.

Results: Patients under plans with lower copayment rates consumed significantly more medication compared with those under plans with higher copayment rates. Under plans with an annual ceiling for insurance coverage, patients spent significantly more in the second half of the year than in the first half of the year. The length of stay was shorter among patients when there were government monitoring and a penalty to the hospital service provider.

Conclusions: Our results indicate that the different designs and monitoring of the health security systems in China cause opportunistic behavior by patients and providers. Reformation is necessary to reduce those incentives, and improve equity and efficiency in healthcare use.

Show MeSH

Related in: MedlinePlus

Summary of Chinese multiple health security systems. UEBMI: Urban Employee Basic Medical Insurance; URBMI: Urban Resident Basic Medical Insurance; NRCMS: New Rural Cooperative System.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4834774&req=5

Figure 1: Summary of Chinese multiple health security systems. UEBMI: Urban Employee Basic Medical Insurance; URBMI: Urban Resident Basic Medical Insurance; NRCMS: New Rural Cooperative System.

Mentions: The financing scheme for current Chinese healthcare consists of a Basic Medical Insurance (BMI) system, a government payment system, and an out-of-pocket payment [Figure 1]. The BMI system includes three mutually exclusive schemes: Urban Employee BMI (UEBMI), Urban Resident BMI (URBMI), and New Rural Cooperative Medical Care System (NRCMS). UEBMI run by the local government and is mandated. The premium is proportional to the employee's salary, meaning that employers provide 6%–8% of their employees’ salaries and employees contribute about 2% of their salaries in general.[8] URBMI is voluntary for urban residents, such as students, the aged, the unemployed, and the disabled. Its premium is funded by both the household and the government.[9] NRCMS, which is voluntary for rural residents, is funded by rural residents and subsidized by the government.[10]


How do patients and providers react to different incentives in the Chinese multiple health security systems?

Zhang CY, Hashimoto H - Chin. Med. J. (2015)

Summary of Chinese multiple health security systems. UEBMI: Urban Employee Basic Medical Insurance; URBMI: Urban Resident Basic Medical Insurance; NRCMS: New Rural Cooperative System.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834774&req=5

Figure 1: Summary of Chinese multiple health security systems. UEBMI: Urban Employee Basic Medical Insurance; URBMI: Urban Resident Basic Medical Insurance; NRCMS: New Rural Cooperative System.
Mentions: The financing scheme for current Chinese healthcare consists of a Basic Medical Insurance (BMI) system, a government payment system, and an out-of-pocket payment [Figure 1]. The BMI system includes three mutually exclusive schemes: Urban Employee BMI (UEBMI), Urban Resident BMI (URBMI), and New Rural Cooperative Medical Care System (NRCMS). UEBMI run by the local government and is mandated. The premium is proportional to the employee's salary, meaning that employers provide 6%–8% of their employees’ salaries and employees contribute about 2% of their salaries in general.[8] URBMI is voluntary for urban residents, such as students, the aged, the unemployed, and the disabled. Its premium is funded by both the household and the government.[9] NRCMS, which is voluntary for rural residents, is funded by rural residents and subsidized by the government.[10]

Bottom Line: Patients under plans with lower copayment rates consumed significantly more medication compared with those under plans with higher copayment rates.Our results indicate that the different designs and monitoring of the health security systems in China cause opportunistic behavior by patients and providers.Reformation is necessary to reduce those incentives, and improve equity and efficiency in healthcare use.

View Article: PubMed Central - PubMed

Affiliation: Department of Health and Social Behavior, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, China.

ABSTRACT

Background: China has achieved universal health insurance coverage. This study examined how patients and hospitals react to the different designs of the plans and to monitoring of patients by the local authority in the Chinese multiple health security schemes.

Methods: The sample for analysis consisted of 1006 orthopedic inpatients who were admitted between January and December 2011 at a tertiary teaching hospital located in Beijing. We conducted general linear regression analyses to investigate whether medical expenditure and length of stay differed according to the different incentives.

Results: Patients under plans with lower copayment rates consumed significantly more medication compared with those under plans with higher copayment rates. Under plans with an annual ceiling for insurance coverage, patients spent significantly more in the second half of the year than in the first half of the year. The length of stay was shorter among patients when there were government monitoring and a penalty to the hospital service provider.

Conclusions: Our results indicate that the different designs and monitoring of the health security systems in China cause opportunistic behavior by patients and providers. Reformation is necessary to reduce those incentives, and improve equity and efficiency in healthcare use.

Show MeSH
Related in: MedlinePlus