Impact of Beijing healthcare reform on the curative care expenditure of outpatients with noncommunicable diseases based on SHA2011 and interrupted time series analysis

Liming Liu,Xuejun Yin,Chen Shen,Yong Yang,Yue Xu,Yan Jiang,Qian Bai,Xiaowei Man,Liying Zhao,Wei Cheng

doi:10.1186/s12913-021-07059-y

Abstract

BackgroundTo analyse the changes in curative care expenditure (CCE) associated with noncommunicable diseases (NCDs) before and after the Beijing healthcare reform, thus providing a reference for the healthcare system.MethodsA total of 60 medical institutions were selected using multistage stratified cluster random sampling in Beijing, China. The records of approximately 100 million outpatients with NCDs in 2016–2018 were extracted. System of Health Accounts 2011 (SHA2011) was used to estimate the CCE. The segmented regression model was established to observe both the instant change and the slope change of intervention in interrupted time series analysis (ITSA). The study was conducted from December 2019 to May 2020 in Beijing, China.ResultsFrom SHA2011, we found that the CCE for outpatients with NCDs in Beijing were 58.59, 61.46 and 71.96 billion RMB in 2016, 2017 and 2018, respectively. The CCE continued to rise at all hospital levels, namely, tertiary, secondary, and community-level hospitals. However, the proportion of CCE in tertiary hospitals decreased. From ITSA, we can also conclude that the CCE showed a significant increasing trend change at the three hospital levels after the intervention. The drug proportion showed a significant decreasing trend change in secondary and tertiary hospitals.ConclusionsBeijing healthcare reform does have an impact on the CCE of NCDs.

Highlights

To analyse the changes in curative care expenditure (CCE) associated with noncommunicable diseases (NCDs) before and after the Beijing healthcare reform, providing a reference for the healthcare system
In 2017, the proportion of CCE spent in community hospitals increased by 2.39 %, and the ratio of CCE in secondary hospitals increased by 3.03 % in 2018
The System of Health Accounts 2011 (SHA2011) results showed that the CCE increased in all three hospital levels from 2016 to 2018, while the interrupted time series analysis (ITSA) results suggested that after the drug sale markup was cancelled, the trend of the CCE significantly increased in all three hospital levels

Summary

Introduction

To analyse the changes in curative care expenditure (CCE) associated with noncommunicable diseases (NCDs) before and after the Beijing healthcare reform, providing a reference for the healthcare system. China has witnessed great changes in the disease spectrum, with NCDs such as stroke and ischaemic heart disease becoming the top two factors negatively affecting people’s life expectancy [1]. In Beijing city in 2016, it was reported that approximately three-quarters of deaths were caused by three NCDs: malignant tumours, heart disease and cerebrovascular diseases [3]. NCDs have imposed a heavy economic burden on the healthcare system in China. Few studies have discussed the medical expenditure of NCDs, which is increasing rapidly [5]

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Discussion

Conclusion