Abstract
This study aimed to evaluate the effects of the differences between two typical payment methods for the new rural cooperative medical scheme (NRCMS) in China on the utilisation of inpatient services. Interrupted time-series analysis (ITSA) and propensity score matching (PSM) were used to measure the difference between two typical payment methods for the NRCMS with regard to the utilisation of inpatient services. After the reform was formally implemented, the level and slope difference after reform compared with pre-intervention (distribution of inpatients in county hospitals (DIC), distribution of inpatients in township hospitals (DIT) and the actual compensation ratio of inpatients (ARCI)) were not statistically significant. Kernel matching obtained better results in reducing the mean and median of the absolute standardised bias of covariates of appropriateness of admission (AA), appropriateness of disease (AD). The difference in AA and AD of the matched inpatients between two groups was −0.03 (p-value = 0.042, 95% CI: −0.08 to 0.02) and 0.21 (p-value < 0.001, 95% CI: −0.17 to 0.25), respectively. The differences in the utilisation of inpatient services may arise owing to the system designs of different payment methods for NRCMS in China. The causes of these differences can be used to guide inpatients to better use medical services, through the transformation and integration of payment systems.
Highlights
The medical service system in rural areas in China is usually defined as the region where the three-level rural medical service network is located, namely the county scope, which includes the three-level rural medical institutions in the county, and the service objects should be consumers within the county scope
Utilisation of inpatient services is a key factor in assessing the effectivity of the payment method for health
We aimed to ensure that the sampling areas can represent the main forms and characteristics of payment systems for new rural cooperative medical scheme (NRCMS) in China
Summary
The medical service system in rural areas in China is usually defined as the region where the three-level rural medical service network is located, namely the county scope, which includes the three-level rural medical institutions in the county, and the service objects should be consumers within the county scope. Health insurance has been increasingly developed worldwide. The payment method for health insurance has an extremely important role in health demand and fund protection, especially for rural areas. Utilisation of inpatient services is a key factor in assessing the effectivity of the payment method for health. Res. Public Health 2019, 16, 1410; doi:10.3390/ijerph16081410 www.mdpi.com/journal/ijerph
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