Abstract
Healthcare reforms (HR) initiated by many countries impacts on healthcare systems worldwide. Being one of fast developing countries, China launched HR in 2009. Better understanding of its impact is helpful for China and others in further pursuit of HR. Here we evaluate inpatient mortality, a proxy to healthcare quality, in 43 top tertiary hospitals in China during this critical period. This is a hospital-based observational study with 8 million discharge summary reports (DSR) from 43 Chinese hospitals from 2010–2012. Using DSRs, we extract the vita status as the outcome, in addition to age, gender, diagnostic codes, and surgical codes. Nearly all hospitals have expanded their hospitalization capacities during this period. As of year 2010, inpatient mortality (IM) across hospitals varies widely from 2‰ to 20‰. Comparing IM of year 2011 and 2012 with 2010, the overall IM has been substantially reduced (OR = 0.883 and 0.766, p-values<0.001), showing steady improvements in healthcare quality. Surgical IM correlates with the overall IM (correlation = 0.60, p-value <0.001), but is less uniform. Over these years, surgical IM has also been steadily reduced (OR = 0.890 and 0.793, p-values<0.001). Further analyses of treatments on five major diseases and six major surgeries revealed that treatments of myocardial infarction, cerebral hemorrhage and cerebral infarction have significant improvement. Observed temporal and spatial variations demonstrate that there is a substantial disparity in healthcare quality across tertiary hospitals, and that these hospitals are rapidly improving healthcare quality. Evidence-based assessment shed light on the reform impact. Lessons learnt here are relevant to further refining HR.
Highlights
Recent economic progress in China has stimulated the continuously increasing demand on the healthcare delivery system and lead the central government to launch multiple healthcare reforms since 1980’s[1, 2]
In addition to assessing overall healthcare quality, we have investigated inpatient mortality (IM) associated with five major diseases as well as six major surgical procedures
This increasing demand appears to be matched by improving healthcare quality
Summary
Recent economic progress in China has stimulated the continuously increasing demand on the healthcare delivery system and lead the central government to launch multiple healthcare reforms since 1980’s[1, 2]. The most recent health care reform, starting from 2009, aims to improve public access to healthcare facilities by establishing government-subsidized insurance programs, regulating essential medicine list, improving referral system, expanding public health services, and piloting hospital reforms[3]. Building upon successes and failures of earlier health care reform efforts, the Chinese government has committed substantial financial resources into the current reform initiatives, leading to an impressive insurance coverage for over 95% of the population, and instituting various ways of delivering healthcare services to the vast population in diverse cities, counties and provinces of China[2]. Beyond focusing only on insurance coverage as the primary evaluation criterion, the healthcare reformers are interested in “patient-centered outcomes”, such as personal health status, patient satisfaction, reduction of financial burden, as well as the focus of this manuscript, the quality of healthcare[3]. Measuring quality of care by healthcare delivery organizations is not a trivial matter, and has to account for many factors, such as the nature of organizations, specialties of care, and sources of referral populations[4]
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