Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China
Abstract Background Medical costs have been rising rapidly in recent years, and China is controlling medical costs from the perspective of health insurance payments. Objectives To explore the impact of the capitation prepayment method on medical expenses and health service utilization of coronary he...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-023-17161-x |
| _version_ | 1797629937304207360 |
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| author | Jincao Yan Yunke Shi Jiani Zhang Siwei Chen Xinran Huo Yue Shen Ning Zhang |
| author_facet | Jincao Yan Yunke Shi Jiani Zhang Siwei Chen Xinran Huo Yue Shen Ning Zhang |
| author_sort | Jincao Yan |
| collection | DOAJ |
| description | Abstract Background Medical costs have been rising rapidly in recent years, and China is controlling medical costs from the perspective of health insurance payments. Objectives To explore the impact of the capitation prepayment method on medical expenses and health service utilization of coronary heart disease (CHD) patients, which provides a scientific basis for further improvement of the payment approach. Methods The diagnosis records of visits for CHD in the database from 2014 to 2016 (April to December each year) were selected, and two townships were randomly selected as the pilot and control groups. Propensity score matching (PSM) and difference-in-difference (DID) model were used to assess changes in outpatient and inpatient expenses and health service utilization among CHD patients after the implementation of the capitation prepayment policy. Results There were eventually 3,900 outpatients and 664 inpatients enrolled in this study after PSM. The DID model showed that in the first year of implementing the reform, total outpatient expenses decreased by CNY 13.953, drug expenses decreased by CNY 11.289, as well as Medicare payments decreased by CNY 8.707 in the pilot group compared to the control group. In the second year of implementing the reform, compared with the control group, the pilot group had a reduction of CNY 3.123 in other expenses, and a reduction of CNY 6.841 in Medicare payments. There was no significant change in inpatient expenses in the pilot group compared to the control group, but there was an increase of 0.829 visits to rural medical institutions, and an increase of 0.750 visits within the county for inpatients. Conclusions The capitation prepayment method has been effective in controlling the outpatient expenses of CHD patients, as well as improving the medical service capacity of medical institutions within the Medical Community, and increasing the rate of inside county visits for inpatients. |
| first_indexed | 2024-03-11T10:59:52Z |
| format | Article |
| id | doaj.art-216740dcde314f03924a23d250a2f186 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-03-11T10:59:52Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-216740dcde314f03924a23d250a2f1862023-11-12T12:32:35ZengBMCBMC Public Health1471-24582023-11-0123111410.1186/s12889-023-17161-xImpact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in ChinaJincao Yan0Yunke Shi1Jiani Zhang2Siwei Chen3Xinran Huo4Yue Shen5Ning Zhang6School of Public Health, Capital Medical UniversitySchool of Public Health, Capital Medical UniversitySchool of Public Health, Capital Medical UniversitySchool of Public Health, Capital Medical UniversitySchool of Public Health, Capital Medical UniversitySchool of Public Health, Capital Medical UniversitySchool of Public Health, Capital Medical UniversityAbstract Background Medical costs have been rising rapidly in recent years, and China is controlling medical costs from the perspective of health insurance payments. Objectives To explore the impact of the capitation prepayment method on medical expenses and health service utilization of coronary heart disease (CHD) patients, which provides a scientific basis for further improvement of the payment approach. Methods The diagnosis records of visits for CHD in the database from 2014 to 2016 (April to December each year) were selected, and two townships were randomly selected as the pilot and control groups. Propensity score matching (PSM) and difference-in-difference (DID) model were used to assess changes in outpatient and inpatient expenses and health service utilization among CHD patients after the implementation of the capitation prepayment policy. Results There were eventually 3,900 outpatients and 664 inpatients enrolled in this study after PSM. The DID model showed that in the first year of implementing the reform, total outpatient expenses decreased by CNY 13.953, drug expenses decreased by CNY 11.289, as well as Medicare payments decreased by CNY 8.707 in the pilot group compared to the control group. In the second year of implementing the reform, compared with the control group, the pilot group had a reduction of CNY 3.123 in other expenses, and a reduction of CNY 6.841 in Medicare payments. There was no significant change in inpatient expenses in the pilot group compared to the control group, but there was an increase of 0.829 visits to rural medical institutions, and an increase of 0.750 visits within the county for inpatients. Conclusions The capitation prepayment method has been effective in controlling the outpatient expenses of CHD patients, as well as improving the medical service capacity of medical institutions within the Medical Community, and increasing the rate of inside county visits for inpatients.https://doi.org/10.1186/s12889-023-17161-xCapitation prepaymentCoronary heart diseasePropensity score matching (PSM)Difference-in-difference (DID) modelReform impactMedical expenses |
| spellingShingle | Jincao Yan Yunke Shi Jiani Zhang Siwei Chen Xinran Huo Yue Shen Ning Zhang Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China BMC Public Health Capitation prepayment Coronary heart disease Propensity score matching (PSM) Difference-in-difference (DID) model Reform impact Medical expenses |
| title | Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China |
| title_full | Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China |
| title_fullStr | Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China |
| title_full_unstemmed | Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China |
| title_short | Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China |
| title_sort | impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease a community policy intervention program in a county in china |
| topic | Capitation prepayment Coronary heart disease Propensity score matching (PSM) Difference-in-difference (DID) model Reform impact Medical expenses |
| url | https://doi.org/10.1186/s12889-023-17161-x |
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