Impact analysis of the county-level public hospital reform on NCMS inpatient expenditure in Hubei province

Abstract

Objective To learn the impacts of county public hospital reform on NCMS inpatient expenditure. Methods Data of 30 107 NCMS-covered inpatients were extracted from county of the province, in the timeframe of January 1, 2012 to June 30, 2013.The difference-in-differences(DID)approach was used to estimate such values as the pre- and post-reform changes as hospitalization spending among others, and reach an estimated DID value. Results We found that the inpatient spending for reform pilot group increased CNY 640 per hospitalization(P=0.000), and the reimbursement ratio increased by 3.4% (P=0.000). The patient out-of-pocket spending however increased by CNY 192(P=0.048). Changes in the spending per category indicate a drop of CNY 89(P=0.084) in the reform pilot group, but an increase of such other spending as examination, treatment, diagnosis, surgery among others.The impacts of the reform policies vary with diseases, which are much higher for common diseases than heart diseases. Conclusions The reform calls for attention to its systematic nature.The financial subsidy, service pricing, payment of physicians, performance management, and regulation of medical behaviors should be taken into a general consideration, accomplishing the general goal of the reform. Key words: Hubei province; County-level public hospitals; New rural cooperative medical system; Inpatient spending; Impacts