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Kiss A, Kiss N, Váradi B. Do budget constraints limit access to health care? Evidence from PCI treatments in Hungary. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:281-302. [PMID: 37074540 PMCID: PMC10156867 DOI: 10.1007/s10754-023-09349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 02/16/2023] [Indexed: 05/03/2023]
Abstract
Under Hungary's single payer health care system, hospitals face an annual budget cap on most of their diagnoses-related group based reimbursements. In July 2012, percutaneous coronary intervention (PCI) treatments of acute myocardial infarction were exempted from that hospital level budget cap. We use countrywide individual-level patient data from 2009 to 2015 to map the effect of such a quasi-experimental change in monetary incentives on health provider decisions and health outcomes. We find that direct admissions into PCI-capable hospitals increase, especially in central Hungary, where there are several hospitals which can compete for patients. The proportion of PCI treatments at PCI-capable hospitals, however, does not increase, and neither does the number of patient transfers from non-PCI hospitals to PCI-capable ones. We conclude that only patient pathways, plausibly influenced by hospital management, were affected by the shift in incentives, while physicians' treatment decisions were not. While average length of stay decreased, we do not find any effect on 30-day readmissions or in-hospital mortality.
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Affiliation(s)
- András Kiss
- KYOS Energy Consulting, Haarlem, The Netherlands.
- Department of Economics, University of Amsterdam, Amsterdam, The Netherlands.
| | - Norbert Kiss
- Institute of Management, Corvinus University of Budapest, Budapest, Hungary
| | - Balázs Váradi
- Department of Economics, ELTE University, Budapest, Hungary
- Budapest Institute for Policy Analysis, Budapest, Hungary
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Yan Y, Tu Y. The impact of China's urban and rural economic revitalization on the utilization of mental health inpatient services. Front Public Health 2023; 10:1043666. [PMID: 36711421 PMCID: PMC9877533 DOI: 10.3389/fpubh.2022.1043666] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/09/2022] [Indexed: 01/13/2023] Open
Abstract
Background Rural locations have a lower preference for mental healthcare than urban areas. Medical and pharmacy expenses incurred as a result of serious mental illness are covered by public health insurance, according to the People's Republic of China's Mental Health Law. This study aimed to acknowledge the disparities in the use of mental health services provided by the government health schemes among the rural and urban populations of China and to assess the real reimbursement rates for health insurance coverage. It also sheds light on China's ongoing healthcare reforms for mental health treatments. Materials and methods A retrospective cohort study of patients was conducted that were hospitalized with mental illnesses to assess rural-urban disparities in the utilization of mental health services and the role of health insurance. We used electronic health data from the major psychiatric institutes for 15 years (2005-2020) to assess the influence of health insurance systems on Chinese public preferences for mental health treatments. These psychiatric hospitals serve almost 10% of all mental health patients every year in Shandong and accept patients from all over the country. In addition, health insurance policy regulations in Shandong Province are consistent with national health insurance policy regulations. Models 1 and 2 assess disparities in the utilization of mental health treatments. Our study population was identified using patients' primary diagnosis, as recorded in the two hospitals' EHRs, which routinely record information on patients' sociodemographic characteristics, clinical characteristics of the disease, cost of the treatment, and type of the health insurance plan. The record of EHR data is considered efficient because they document all inpatient expenses incurred during hospitalization in a detailed, itemized, and reliable way. Results Urban patients had longer hospital stays (p = 0.0001), more hospitalizations (p = 0.006), and greater hospitalization expenses (p = 0.001) than rural patients. Patients who had insurance had a longer hospital stay (p = 0.0001), more hospitalizations (p = 0.0001), and greater hospitalization costs (p = 0.0001) than those who did not have insurance. Urban residents used mental health services more than rural residents. People preferred mental healthcare when the reimbursement ratio variable was larger, especially in rural areas. Conclusion Rural people of China experience mental health services are an economic burden. Uniform measures are required to be taken for the development of health insurance policies for people in rural areas.
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Affiliation(s)
- Yu Yan
- School of Law, Guangdong University of Technology, Guangzhou, Guangdong, China,*Correspondence: Yu Yan
| | - Yongqian Tu
- National Academy of Development and Strategies, Renmin University of China, Beijing, China,Yongqian Tu
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Erlangga D, Suhrcke M, Ali S, Bloor K. The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PLoS One 2019; 14:e0219731. [PMID: 31461458 PMCID: PMC6713352 DOI: 10.1371/journal.pone.0219731] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Expanding public health insurance seeks to attain several desirable objectives, including increasing access to healthcare services, reducing the risk of catastrophic healthcare expenditures, and improving health outcomes. The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years. METHODS We reviewed systematically empirical studies published from July 2010 to September 2016 using Medline, Embase, Econlit, CINAHL Plus via EBSCO, and Web of Science and grey literature databases. No language restrictions were applied. Our focus was on both randomised and observational studies, particularly those including explicitly attempts to tackle selection bias in estimating the treatment effect of health insurance. The main outcomes are: (1) utilisation of health services, (2) financial protection for the target population, and (3) changes in health status. FINDINGS 8755 abstracts and 118 full-text articles were assessed. Sixty-eight studies met the inclusion criteria including six randomised studies, reflecting a substantial increase in the quantity and quality of research output compared to the time period before 2010. Overall, health insurance schemes in low- and middle-income countries (LMICs) have been found to improve access to health care as measured by increased utilisation of health care facilities (32 out of 40 studies). There also appeared to be a favourable effect on financial protection (26 out of 46 studies), although several studies indicated otherwise. There is moderate evidence that health insurance schemes improve the health of the insured (9 out of 12 studies). INTERPRETATION Increased health insurance coverage generally appears to increase access to health care facilities, improve financial protection and improve health status, although findings are not totally consistent. Understanding the drivers of differences in the outcomes of insurance reforms is critical to inform future implementations of publicly funded health insurance to achieve the broader goal of universal health coverage.
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Affiliation(s)
- Darius Erlangga
- Department of Health Sciences, University of York, York, England, United Kingdom
| | - Marc Suhrcke
- Centre of Health Economics, University of York, York, England, United Kingdom
- Luxembourg Institute of Socio-economic Research (LISER), Luxembourg
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, England, United Kingdom
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Karen Bloor
- Department of Health Sciences, University of York, York, England, United Kingdom
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Wang L, Shi H, Huang JL, Xu S, Liu PP. Linggui Zhugan Decoction (苓桂术甘汤) Inhibits Ventricular Remodeling after Acute Myocardial Infarction in Rats by Suppressing TGF-β1/Smad Signaling Pathway. Chin J Integr Med 2019; 26:345-352. [DOI: 10.1007/s11655-018-3024-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 01/27/2023]
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Xu J, Wang J, King M, Liu R, Yu F, Xing J, Su L, Lu M. Rural-urban disparities in the utilization of mental health inpatient services in China: the role of health insurance. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2018; 18:377-393. [PMID: 29589249 PMCID: PMC6223725 DOI: 10.1007/s10754-018-9238-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 03/17/2018] [Indexed: 05/28/2023]
Abstract
Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China's on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China. This retrospective study used 10 years (2005-2014) of hospital electronic health records from the Shandong Center for Mental Health and the DaiZhuang Psychiatric Hospital, two major psychiatric hospitals in Shandong Province. Health insurance was measured using types of health insurance and the actual reimbursement ratio (RR). Utilization of mental health inpatient services was measured by hospitalization cost, length of stay (LOS), and frequency of hospitalization. We examined rural-urban disparities in the use of mental health services, as well as the role of health insurance in reducing such disparities. Hospitalization costs, LOS, and frequency of hospitalization were all found to be lower among rural than among urban inpatients. Having health insurance and benefiting from a relatively high RR were found to be significantly associated with a greater utilization of inpatient services, among both urban and rural residents. In addition, an increase in the RR was found to be significantly associated with an increase in the use of mental health services among rural patients. Consistent with the existing literature, our study suggests that increasing insurance schemes' reimbursement levels could lead to substantial increases in the use of mental health inpatient services among rural patients, and a reduction in rural-urban disparities in service utilization. In order to promote mental health care and reduce rural-urban disparities in its utilization in China, improving rural health insurance coverage (e.g., reducing the coinsurance rate) would be a powerful policy instrument.
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Affiliation(s)
- Junfang Xu
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Jian Wang
- Center for Health Economic Experiments and Public Policy, Department of Social Medicine and Administration, School of Public Health, Shandong University, No. 44 Wen Hua Xi Road, Jinan, Shandong, China.
| | - Madeleine King
- School of Public Policy and Management, Tsinghua University, Beijing, China
| | - Ruiyun Liu
- Shandong Center for Mental Health, Jinan, Shandong, China
| | - Fenghua Yu
- Shandong Health and Family Planning Commission, Jinan, Shandong, China
| | - Jinshui Xing
- Shandong Center for Mental Health, Jinan, Shandong, China
| | - Lei Su
- Shandong Center for Mental Health, Jinan, Shandong, China
| | - Mingshan Lu
- Department of Economics, University of Calgary, Calgary, Canada
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The effects of patient cost sharing on inpatient utilization, cost, and outcome. PLoS One 2017; 12:e0187096. [PMID: 29073234 PMCID: PMC5658166 DOI: 10.1371/journal.pone.0187096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 10/15/2017] [Indexed: 11/19/2022] Open
Abstract
Background Health insurance and provider payment reforms all over the world beg a key empirical question: what are the potential impacts of patient cost-sharing on health care utilization, cost and outcomes? The unique health insurance system and rich electronic medical record (EMR) data in China provides us a unique opportunity to study this topic. Methods Four years (2010 to 2014) of EMR data from one medical center in China were utilized, including 10,858 adult patients with liver diseases. We measured patient cost-sharing using actual reimbursement ratio (RR) which is allowed us to better capture financial incentive than using type of health insurance. A rigorous risk adjustment method was employed with both comorbidities and disease severity measures acting as risk adjustors. Associations between RR and health use, costs and outcome were analyzed by multivariate analyses. Results After risk adjustment, patients with more generous health insurance coverage (higher RR) were found to have longer hospital stay, higher total cost, higher medication cost, and higher ratio of medication to total cost, as well as higher number and likelihood that specific procedures were performed. Conclusion Our study implied that patient cost-sharing affects health care services use and cost. This reflects how patients and physicians respond to financial incentives in the current healthcare system in China, and the responses could be a joint effect of both demand and supply side moral hazard. In order to contain cost and improve efficiency in the system, reforming provide payment and insurance scheme is urgently needed.
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Introduction to the history and current status of evidence-based korean medicine: a unique integrated system of allopathic and holistic medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:740515. [PMID: 24834097 PMCID: PMC4009338 DOI: 10.1155/2014/740515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/09/2014] [Accepted: 01/10/2014] [Indexed: 12/02/2022]
Abstract
Objectives. Korean medicine, an integrated allopathic and traditional medicine, has developed unique characteristics and has been active in contributing to evidence-based medicine. Recent developments in Korean medicine have not been as well disseminated as traditional Chinese medicine. This introduction to recent developments in Korean medicine will draw attention to, and facilitate, the advancement of evidence-based complementary alternative medicine (CAM). Methods and Results. The history of and recent developments in Korean medicine as evidence-based medicine are explored through discussions on the development of a national standard classification of diseases and study reports, ranging from basic research to newly developed clinical therapies. A national standard classification of diseases has been developed and revised serially into an integrated classification of Western allopathic and traditional holistic medicine disease entities. Standard disease classifications offer a starting point for the reliable gathering of evidence and provide a representative example of the unique status of evidence-based Korean medicine as an integration of Western allopathic medicine and traditional holistic medicine. Conclusions. Recent developments in evidence-based Korean medicine show a unique development in evidence-based medicine, adopting both Western allopathic and holistic traditional medicine. It is expected that Korean medicine will continue to be an important contributor to evidence-based medicine, encompassing conventional and complementary approaches.
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Liang W, Xie J, Fu H, Wu EQ. The role of health economics and outcomes research in health care reform in China. PHARMACOECONOMICS 2014; 32:231-234. [PMID: 24554475 PMCID: PMC3937542 DOI: 10.1007/s40273-014-0141-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Wannian Liang
- Department of Healthcare Reform, Office of State Council Health Reform Leading Group, National Health and Family Planning Commission of the People’s Republic of China, Beijing, China
| | - Jipan Xie
- Analysis Group, Inc., 111 Huntington Ave, 10th Floor, Boston, MA 02199 USA
| | - Hongpeng Fu
- Department of Medicine Policy, China National Health Development and Research Center, Beijing, China
| | - Eric Q. Wu
- Analysis Group, Inc., 111 Huntington Ave, 10th Floor, Boston, MA 02199 USA
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