Effect of integrated urban and rural residents' medical insurance on the cost of services to patients with severe mental illness in China: a cross-sectional study

Abstract

BackgroundMental illness is often a chronic disease involving long treatment durations. It is characterised by high relapse rates and a high degree of disability, resulting in high socioeconomic aggregate costs to families and the health insurance system. However, the evidence of policy effects on the cost of mental illness to patients is insufficient. In 2016, the Chinese Government integrated the Urban Resident Basic Medical Insurance (URBMI) with the Rural New Cooperative Medical Scheme (RNCMS) to form the Urban and Rural Resident Basic Medical Insurance Scheme (URRBMI). We aimed to evaluate the effect of this policy integration on the medical and out-of-pocket costs of accessing mental health services to patients with severe mental illness in a single province in China. MethodsThis study is based on random stratified sampling of the medical record data of patients with severe mental illness in 21 cities in a single province in China from Jan 1, 2014, to Dec 31, 2017. We divided the cities into four categories based on the year of implementation of the integration policy. We applied propensity score matching with a difference-in-difference approach to analyse the effect of the integration policy on the medical costs to patients with severe mental illness. FindingsEstablishment of URRMI was associated with significantly reduced total medical and out-of-pocket costs to patients with severe mental illness (p<0·01 for both), and the effect increased over time. The reduction in total medical costs appeared to be caused by reduced diagnosis and medicine costs. The medical cost gap between patients in urban and rural settings decreased from 189·1% before policy integration to 59·2% after policy integration. InterpretationThe results suggest that integrating the URBMI with the RNCMS effectively reduced medical costs to patients with severe mental illness. Although the URRMI scheme appeared to reduce the cost gap between rural and urban residents, more efforts should be spent on decreasing the out-of-pocket costs of severe mental illness in rural patients. FundingThis study was funded by Research on Deepening the Reform of Medical and Health Systems and Promoting the Construction of Healthy Sichuan, major research director of the soft science research project, Science & Technology Department of Sichuan Province (number 2019JDR0057).