Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

Effects of changes in health insurance reimbursement level on outpatient service utilization of rural diabetics: evidence from Jiangsu Province, China

Authors: Lu Zhang, Zhonghua Wang, Dongfu Qian, Jian Ni

Published in: BMC Health Services Research | Issue 1/2014

Login to get access

Abstract

Background

Outpatient reimbursement levels of the New Rural Cooperative Medical Scheme have changed in recent years in China, and those changes may have a greater impact on patients with chronic diseases due to their higher outpatient expenses. This study represents the first attempt to identify the effects of reimbursement level on outpatient service utilization for chronic patients in rural China and it also gives strong estimation results by conducting a tracer illness study in order to control for possible biases associated with studying several diseases together.

Methods

This study used difference-in-differences models to examine how changes in yearly maximum reimbursement amount and outpatient reimbursement rates affected rural residents with type 2 diabetes in three counties in Jiangsu Province, China. Other factors, such as sex, age and severity of illness, were also included in the model estimations. To make sure the treated group and control group are comparable, Propensity Score Match (PSM) was used to analysis the gender, age and severity of illness of the two groups.

Results

The results indicate that an increase in yearly maximum reimbursement amount for outpatient visits could cause an increase in yearly total outpatient expenses for patients with type 2 diabetes mellitus. However, changes in outpatient reimbursement rates between 2010 and 2011 did not significantly affect the utilization of different types of health institution.

Conclusions

The reimbursement rates of village clinics should be substantially increased from the existing basis and the gap of reimbursement rates among different institutions should be further widened. It is also important for village clinics to improve their services. Moreover, measures to improve the quality of care and scope of services at lower-level healthcare institutions, and promote the health service utilization of rural women should be considered.
Literature
1.
Wang L, Kong L, Wu F, Bai Y, Burton R: Preventing chronic diseases in China. Lancet. 2005, 366: 1821-1824. 10.1016/S0140-6736(05)67344-8.CrossRefPubMed
2.
Lin J, Zhang L, Xu Z, Xu L: Research on burden of chronic diseases among rural–urban residents in Xuzhou. Public Health. 2010, 124: 345-349. 10.1016/j.puhe.2010.03.004.CrossRefPubMed
3.
Daar AS, Singer PA, Persad DL, Pramming SK, Matthews DR, Beaglehole R, Bernstein A, Borysiewicz LK, Colagiuri S, Ganguly N, Glass RI, Finegood DT, Koplan J, Nabel EG, Sarna G, Sarrafzadegan N, Smith R, Yach D, Bell J: Grand challenges in chronic non-communicable diseases. Nature. 2007, 450: 494-496. 10.1038/450494a.CrossRefPubMed
4.
Ministry of Health, China: China National Health Household Interview Surveys. 2009, Beijing: Peking Union Medical College Press
5.
Zhang X, Guan T, Mao J, Liu L: Disparity and its time trends in stroke mortality between urban and rural populations in China 1987 to 2001: changing patterns and their implications for public health policy. Stroke. 2007, 38: 3139-3144. 10.1161/STROKEAHA.107.494336.CrossRefPubMed
6.
Li Q: The actually investigation about the impact of the NRCMS on accessibility of rural healthcare in five counties of Fujian Province. 2009, Fujian: School of health policy, Fujian Medical University
7.
8.
You X, Kobayashi Y: The new cooperative medical scheme in China. Health Policy. 2009, 91: 1-9. 10.1016/j.healthpol.2008.11.012.CrossRefPubMed
9.
Long Q, Klemetti R, Wang Y, Tao F, Yan H, Hemminki E: High caesarean section rate in rural China: is it related to health insurance (New Co-operative Medical Scheme)?. Soc Sci Med. 2010, 75: 733-737.CrossRef
10.
Zhao D, Wang Z, Ren J, Song D, Yang J: Analysis of New Rural Cooperative Medical System reimbursement policy for special diseases in outpatient services. Chin Health Econ. 2012, 31: 48-51.
11.
Sang X, Yin A, Song C: Economic burden of hypertension and diabetes patients and compensation by New Rural Medical System in rural areas. Chin J Public Health. 2010, 26: 606-608.
12.
Lin Y, Tian W, Chen C: Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan. Health Policy. 2011, 103: 236-243. 10.1016/j.healthpol.2011.08.007.CrossRefPubMed
13.
Saksena P, Antunes AF, Xu K, Musango L, Carrin G: Mutual health insurance in Rwanda evidence on access to care and financial risk protection. Health Policy. 2011, 99: 203-209. 10.1016/j.healthpol.2010.09.009.CrossRefPubMed
14.
Kondo A, Shigeoka H: Effects of universal health insurance on health care utilization, and supply-side responses: evidence from Japan. J Public Econ. 2013, 99: 1-23.CrossRef
15.
Wagstaff A, Lindelow M: Can insurance increase financial risk? The curious case of health insurance in China. J Health Econ. 2008, 27: 990-1005. 10.1016/j.jhealeco.2008.02.002.CrossRefPubMed
16.
17.
Solanki G, Schauffler HH: Cost-sharing and the utilization of clinical preventive services. Am J Prev Med. 1999, 19: 127-133.CrossRef
18.
Dormuth CR, Glynn RJ, Neumann P, Maclure M, Brookhart AM, Schneeweiss S: Impact of two sequential drug cost-Sharing policies on the use of inhaled medications in older patients with chronic obstructive pulmonary disease or asthma. Clin Ther. 2006, 28: 964-978. 10.1016/j.clinthera.2006.06.007.CrossRefPubMed
19.
Dormuth CR, Maclure M, Glynn RJ, Neumann P, Brookhart AM, Schneeweiss S: Emergency hospital admissions after income-based deductibles and prescription copayments in older users of inhaled medications. Clin Ther. 2008, 30: 1038-1050.CrossRefPubMedPubMedCentral
20.
Zuo Y, Hu S, Liu B, Jiang Q: Outpatient reimbursement scheme’ impact on health service utilization and management way under New Rural Cooperative Medical Scheme. Health Econ Res. 2008, 2: 18-20.
21.
Yang H: Effect analysis for New Rural Cooperative Medical Scheme two kind of outpatient service reimbursement in Dali. Chin Health Econ. 2009, 28: 42-45.
22.
Mao Y, Wang H, Xu Y, Shi H, Yang C, Chen Q: Construction and application of reimbursement ratio measuring model of pooling outpatient service under New Rural Cooperative Medical Scheme. Chin Health Stat. 2010, 27: 291-292.
23.
Xu C, Wang Z, Meng H: Outpatient reimbursement schematic study of New Rural Cooperative Medical Scheme—based on the comparison among 32 county outpatient reimbursement schemes. Rural Econ. 2010, 9: 79-82.
24.
Huang X, Wang Q, Gu X, Xiang C, Li T, Mao Z: Research on influence of New Rural Cooperative Medical Scheme Out-patient Reimbursement Plan on Choosing Medical institution. Chin Health Stat. 2012, 31: 48-51.
25.
Fosu GB: Childhood morbidity and health services utilization: cross-national comparisons of user-related factors from DHS data. Soc Sci Med. 1994, 38: 1209-1220. 10.1016/0277-9536(94)90186-4.CrossRefPubMed
26.
Pillai RK, Williams SV, Glick HA, Polsky D, Berlin JA, Lowe RA: Factors affecting decisions to seek treatment for sick children in Kerala, India. Soc Sci Med. 2003, 57: 783-790. 10.1016/S0277-9536(02)00448-3.CrossRefPubMed
27.
Tian F: Preliminary analysis of diabetes status in China. Chin J Epidemiol. 1998, 19: 361-362.
28.
Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, He J: Prevalence of diabetes among men and women in China. N Engl J Med. 2010, 362: 1098.CrossRef
29.
Mao L, Lan G: Death cause analysis of inpatients with type 2 diabetes mellitus. Guangdong Med J. 2011, 32: 1592-1594.
30.
Wang J, Zhang Q, Jing S: Disease burden analysis of hypertension and diabetes in China. J Publ Health Prev Med. 2007, 18: 27-30.
31.
Zhang Z, Chen J, Tang Z, Hu R, Lu B: Direct health service expense research of diabetes in China. Chin Health Res. 2007, 10: 162-164.
32.
Yan R: Concerns about relieving disease economical burden of diabetes in county. Chin Prim Health Care. 2006, 20: 13-14.
33.
34.
Hausman J, Kuersteiner G: Difference in difference meets generalized least squares: higher order properties of hypotheses tests. J Econ. 2008, 144: 371-391. 10.1016/j.jeconom.2008.04.003.CrossRef
35.
Chang R, Hsieh C, Myrtle R: The effect of outpatient dialysis global budget cap on healthcare utilization by end-stage renal disease patients. Soc Sci Med. 2011, 73: 153-159. 10.1016/j.socscimed.2011.05.007.CrossRefPubMed
36.
Songer TJ: The role of cost–effectiveness analysis and health insurance in diabetes care. Diabetes Res Clin Pract. 2001, 54: 7-11.CrossRef
Metadata
Title
Effects of changes in health insurance reimbursement level on outpatient service utilization of rural diabetics: evidence from Jiangsu Province, China
Authors
Lu Zhang
Zhonghua Wang
Dongfu Qian
Jian Ni
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-14-185

Other articles of this Issue 1/2014

BMC Health Services Research 1/2014 Go to the issue

Research article

Characteristics affecting oral anticoagulant therapy choice among patients with non-valvular atrial fibrillation: a retrospective claims analysis

Research article

Learning organizations, internal marketing, and organizational commitment in hospitals

Research article

Assessment of paediatric inpatient care during a multifaceted quality improvement intervention in Kenyan District Hospitals – use of prospectively collected case record data

Research article

How physicians identify with predetermined personalities and links to perceived performance and wellness outcomes: a cross-sectional study

Research article

A qualitative study of contextual factors’ impact on measures to reduce surgery cancellations

Research article

Financial protection effects of modification of China’s New Cooperative Medical Scheme on rural households with chronic diseases