Abstract
Worldwide, healthcare policy change ranks among the top three issues in the public’s consciousness. This study introduces a case study of pediatric hospitalizations at one hospital in Northern China. It seeks to assess whether pediatric hospitalization access, costs, and costs structures favorably changed after selected health policy reforms were implemented in China. A census of all hospital pediatric discharge data from 2015 to 2018 were collected from a general public tertiary hospital in Northern China. Using generalized linear regression, changes in charges for length of stay, daily charges, total charges per discharge, and drug charges and medical service fees as a percent of total charges were analyzed as a function of two independent variables - policy changes regarding the merger of two health insurance programs, and the zero-markup drug pricing policy. These variables were included as dummy variables for the pre-and-post change periods. The covariates used included patient age, sex, and the year. After the policy implementation, significant decreases (P<.01) were found in the length of the hospital stay (-0.49 days) and drug and medical charges (-7.63%) as a percent of total charges. A significant decrease also occurred (P<.01) in the number and percent of pediatric patients served who were self-pay after the merger of the NCMS insurance plan into the URBMI. Drug costs as a proportion of total costs also decreased significantly (P<.01). Thus, the findings revealed that the zero-markup drug pricing policy was associated with a significant decrease (P<.01) in the mean percentage markup for drug charges (P<.01). Accordingly, both health policy changes were associated with positive effects on pediatric healthcare expenditures, and access. This research suggests that as these two policies are fully implemented at public tertiary hospitals throughout China, pediatric hospital care may become even more accessible and drugs less costly.
Highlights
Pediatric health care can be characterized by patterns of underinvestment in both mature and developing countries
It is less than surprising that a key component of healthcare reform worldwide has been the specific inclusion of policy changes that seek to align with improvements in pediatric health
Grace et al (2015) highlights the fact that whether reviewing actual health policy changes such as those included in the Affordable Care Act and/or other reform efforts in the United States, pediatric health policy changes have been an intricate component of the proposed measures
Summary
Pediatric health care can be characterized by patterns of underinvestment in both mature and developing countries. It is less than surprising that a key component of healthcare reform worldwide has been the specific inclusion of policy changes that seek to align with improvements in pediatric health. Grace et al (2015) highlights the fact that whether reviewing actual health policy changes such as those included in the Affordable Care Act and/or other reform efforts in the United States, pediatric health policy changes have been an intricate component of the proposed measures. Arnold (2016) makes a highly compelling argument for a body of scholarship that utilizes evidence from policy changes worldwide in order to gain instruction on assessing whether various policy changes occur in a delayed tandem with pediatric health improvements. Arnold states, “When it comes to children, there is no “them” and “us”...we must commit to improving the lives of children
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