Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China
Abstract Background In China, increases in both the caesarean section (CS) rates and delivery costs have raised questions regarding the reform of the medical insurance payment system. Case payment is useful for regulating the behaviour of health providers and for controlling the CS rates and excessi...
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| Format: | Article |
| Language: | English |
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BMC
2018-03-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | http://link.springer.com/article/10.1186/s12884-018-1698-0 |
| _version_ | 1819144816634626048 |
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| author | Shuang Liu Jing Wang Liang Zhang Xiang Zhang |
| author_facet | Shuang Liu Jing Wang Liang Zhang Xiang Zhang |
| author_sort | Shuang Liu |
| collection | DOAJ |
| description | Abstract Background In China, increases in both the caesarean section (CS) rates and delivery costs have raised questions regarding the reform of the medical insurance payment system. Case payment is useful for regulating the behaviour of health providers and for controlling the CS rates and excessive increases in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aimed to observe the changes in the CS rates, compare the changes in delivery-related variables, and identify variables related to delivery costs before and after the CPR in Xi County. Methods Overall, 28,314 cases were selected from the Xi County NCMS agency from 2009 to 2010 and from 2014 to 2015. One-way ANOVA and chi-square tests were used to compare the distributions of CS and vaginal delivery (VD) before and after the CPR under different indicators. We applied multivariate linear regressions for the total medical cost of the VD and CS groups and total samples to identify the relationships between medical expenses and variables. Results The CS rates in Xi County increased from 26.1% to 32.5% after the CPR. The length of stay (LOS), total medical cost, and proportion of county hospitals increased in the CS and VD groups after the CPR, which had significant differences. The total medical cost in the CS and VD groups as well as the total samples was significantly influenced by inpatient age, LOS, and hospital type, and had a significant correlation with the CPR in the VD group and the total samples. Conclusion The CPR might fail to control the growth of unreasonable medical expenses and regulate the behaviour of providers, which possibly resulted from the unreasonable compensation standard of case payments, prolonged LOS, and the increasing proportion of county hospitals. The NCMS should modify the case payment standard of delivery to inhibit providers’ motivation to render CS services. The LOS should be controlled by implementing clinical guidelines, and a reference system should be established to guide patients in choosing reasonable hospitals. |
| first_indexed | 2024-12-22T12:48:09Z |
| format | Article |
| id | doaj.art-cc29e7909d0843be96c150c0c2e69928 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-22T12:48:09Z |
| publishDate | 2018-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-cc29e7909d0843be96c150c0c2e699282022-12-21T18:25:16ZengBMCBMC Pregnancy and Childbirth1471-23932018-03-011811710.1186/s12884-018-1698-0Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, ChinaShuang Liu0Jing Wang1Liang Zhang2Xiang Zhang3Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and TechnologyAbstract Background In China, increases in both the caesarean section (CS) rates and delivery costs have raised questions regarding the reform of the medical insurance payment system. Case payment is useful for regulating the behaviour of health providers and for controlling the CS rates and excessive increases in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aimed to observe the changes in the CS rates, compare the changes in delivery-related variables, and identify variables related to delivery costs before and after the CPR in Xi County. Methods Overall, 28,314 cases were selected from the Xi County NCMS agency from 2009 to 2010 and from 2014 to 2015. One-way ANOVA and chi-square tests were used to compare the distributions of CS and vaginal delivery (VD) before and after the CPR under different indicators. We applied multivariate linear regressions for the total medical cost of the VD and CS groups and total samples to identify the relationships between medical expenses and variables. Results The CS rates in Xi County increased from 26.1% to 32.5% after the CPR. The length of stay (LOS), total medical cost, and proportion of county hospitals increased in the CS and VD groups after the CPR, which had significant differences. The total medical cost in the CS and VD groups as well as the total samples was significantly influenced by inpatient age, LOS, and hospital type, and had a significant correlation with the CPR in the VD group and the total samples. Conclusion The CPR might fail to control the growth of unreasonable medical expenses and regulate the behaviour of providers, which possibly resulted from the unreasonable compensation standard of case payments, prolonged LOS, and the increasing proportion of county hospitals. The NCMS should modify the case payment standard of delivery to inhibit providers’ motivation to render CS services. The LOS should be controlled by implementing clinical guidelines, and a reference system should be established to guide patients in choosing reasonable hospitals.http://link.springer.com/article/10.1186/s12884-018-1698-0Cost controlIntegrated case paymentNew cooperative medical schemeCaesarean section rateDelivery |
| spellingShingle | Shuang Liu Jing Wang Liang Zhang Xiang Zhang Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China BMC Pregnancy and Childbirth Cost control Integrated case payment New cooperative medical scheme Caesarean section rate Delivery |
| title | Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China |
| title_full | Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China |
| title_fullStr | Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China |
| title_full_unstemmed | Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China |
| title_short | Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China |
| title_sort | caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery evidence from xi county china |
| topic | Cost control Integrated case payment New cooperative medical scheme Caesarean section rate Delivery |
| url | http://link.springer.com/article/10.1186/s12884-018-1698-0 |
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