The impact of medical insurance policies on the hospitalization services utilization of people with schizophrenia: A case study in Changsha, China

Yi Feng,Fei Luo,Xianjun Xiong,Qiuji Xue,Lan Yao,Li Xiang

doi:10.12669/pjms.293.3273

Abstract

To evaluate the impact of two medical insurers' policies on the hospitalization of people with schizophrenia and the economic burden they faced during a period of rapid health services reform in China. A comparative analysis was made of Urban Employee-Basic Medical Insurance (UE-BMI) and Urban Residents-Basic Medical Insurance (UR-BMI) policies on the medical management of schizophrenics, and was compared with hospitalization expenses, insurer reimbursement data and other information collected from the HMO (health maintenance organization) and social insurance agencies on the care of people with schizophrenia in Changsha in 2010. In-depth interviews were also conducted with relevant managers. Compared with inpatients covered by UR-BMI, the inpatients of UE-BMI were admitted to higher level medical institutions and were prescribed expensive second generation antipsychotics (SGA) medicines. Nevertheless, the hospitalization service utilization and cost of inpatients' hospitalization under UE-BMI were far less than that of inpatients under UR-BMI. The insurance level difference between two medical insurance schemes influences the treatment regimens and benefits received by patients. Furthermore, the integration of schizophrenia management into the outpatient services pooling fund for special diseases(OS-PFSD) can appropriately reduce hospitalization utilization, which, together with the payment way reform and the prescription of reasonable medications, can significantly reduce the overall hospitalization cost for patients.

Highlights

These were conducted in order to reveal the practical implications of the medical insurance management policies, their impact on, and the problems faced by people with schizophrenia in the utilization of outpatient and inpatient medical services in Changsha
The impact of integrating schizophrenia management into outpatient services pooling fund for special diseases (OS-PFSD) on patients’ utilization of hospitalization and hospitalization cost: Mr Dai, Deputy Director General of Changsha Municipal Medical Insurance Bureau, stated that “since Urban Employee-Basic Medical Insurance (UE-BMI)’s integration of schizophrenia management into OS-PFSD, less ill patients and those recovering patients who can be treated by both outpatient service and hospitalization were transferred to outpatient treatment, decreasing the inpatients amount and length of stay
Yu et al[13] proposed that the establishment of a pooling fund of outpatient services is beneficial for early disease detection, early diagnosis and early treatment, which can encourage appropriate use of health services to the maximum extent and avoid delays in treatment that lead to minor illness unnecessarily becoming serious illness with its associated higher costs of care

Summary

Methods

Materials: A field survey was conducted to collect the policy documents and implementation methods for the medical insurance management of schizophrenia in both UE-BMI and UR-BMI at the Changsha municipal HMO. Interview: The data analysis was supplemented with in-depth interviews conducted with fifteen managers of Changsha Municipal HMO, Social Insurance Agencies, Health Bureau, three specialized mental health hospitals and five community health service centers. These were conducted in order to reveal the practical implications of the medical insurance management policies, their impact on, and the problems faced by people with schizophrenia in the utilization of outpatient and inpatient medical services in Changsha. Data analysis: An analysis comparing the two medical insurance management policies for people with schizophrenia was carried out It covered hospitalization rates, lengths of stay, inpatient flow, hospitalization expense levels and allocation, hospital medication and utilization of other hospitalization services in Changsha in 2010. Data were analyzed using SPSS for Windows (Version 16.0)

Results

Discussion

Conclusion