Did capitation payment reform make a difference in Chinese rural primary health care?

Abstract

This paper evaluated the effect of capitation payment reform in New Rural Cooperative Medical Scheme designating primary facilities in Qianjiang 2007-2009. Retrospective administrative claims were analyzed. Intercepts changes of cost per visit in facilities started the reform in different stages and of overall Qianjiang were compared. Referral rate, prescribing indicators, hospitalization rate, income of facility and individuals were compared pre- and post- the reform. Growth rate of cost per visit in health centers was contained in 2008, kept unchanged in 2009. Cost containment effect on village clinics was observed in each starting stage of reforms, but vanished later on. Except for the fact the proportion of essential medicines used in health centers significantly increased (X2 test, P<0.05), prescription indicators were not improved significantly in all facilities. After a slight increase in 2007, the hospitalization rate continuously dropped. The monthly income and outpatient revenue continuously increased in 2006-2009. Cost containment objective of the capitation reform was achieved immediately following the reform, but was not sustainable. Provider behaviors were partially improved with limited effects on prescriptions behaviors. The reform brought no financial loss to both the facilities and individuals.