Front. Med. 2016, 10(4): 473–480 DOI 10.1007/s11684-016-0479-2
RESEARCH ARTICLE
Effect of the new maternity insurance scheme on medical expenditures for caesarean delivery in Wuxi, China:
a retrospective pre/post-reform case study
Chun Chen1,2, Zhihong Cheng3, Ping Jiang3, Mei Sun2, Qi Zhang (✉)4,a, Jun Lv (✉)2,b
1School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China; 2Research Institute of Health Development
Strategies, Fudan University, Shanghai 200032, China; 3Affiliated Hospital, Jiangnan University, Wuxi 214062, China; 4School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA
copy; Higher Education Press and Springer-Verlag Berlin Heidelberg 2016
Abstract Aiming to control rising medical expenditures and help improve Chinarsquo;s healthcare systems, this study
examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitalsrsquo; C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China (2004–2013), and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform. We also used paired sample t-tests and linear regression models to compare the mean medical expenditures between insured and uninsured women undergoing caesarean delivery during the post-reform period. After the schemersquo;s implementation, medical expenditures for caesarean deliveries declined and the medical expenditures of women covered by the scheme were significantly lower than those of uninsured patients. These findings indicated the schemersquo;s effectiveness in minimizing caesarean delivery expenditures. The cap-based medical insurance scheme with shared financial interest between insurance and healthcare providers would likely steer healthcare providersrsquo; behaviors in a more cost-effective direction.
Keywords maternity insurance scheme; financial incentive; caesarean delivery; medical expenditure; China
Introduction
Public hospitals in developing countries, such as China, consume more healthcare resources and have observed rising medical care expenditures compared with preventive and primary healthcare facilities [1]. Therefore, govern- ment agencies at different levels are exploring a feasible public hospital payment method to help reshape the financial incentives of healthcare providers and achieve a cost-effective healthcare system. China, which is under- taking healthcare reform, also formulated health policies to improve public hospitalsrsquo; payment methods at both national and regional levels [2].
The caesarean section (C-section) is a standard surgical procedure that is performed worldwide and annually consumes billions of dollars of healthcare resources [3].
Received February 15, 2016; accepted August 12, 2016 Correspondence: aqzhang@odu.edu; blujun@shmu.edu.cn
Therefore, C-section medical expenditures have received comprehensive attention from scholars and governments worldwide, including China.
Various factors affect the medical expenditures asso- ciated with C-sections, including demographics such as age, income, educational level, insurance status, and clinical conditions [4]; institutional factors such as size, geographical location, and type of institution [5]; and policy factors such as source of payment, malpractice liability, and financial incentives [3].
Additional research on policy factors, such as national or regional insurance schemes, is necessary to reduce financial barriers to obstetric care, particularly in develop- ing or low-income countries [6–9]. Chinarsquo;s national and regional maternity insurance scheme (MIS) is the key policy connecting payment source and financial incentives related to C-section medical expenses. Therefore, more research on the effectiveness of Chinarsquo;s MIS is necessary to control rising medical expenditures and help improve the healthcare systems of other countries or regions.
Chinese MIS
In China, the MIS and basic health insurance schemes are separate yet related, as both are important social insurance schemes and were established through national legislation. However, the MIS has distinct features with regard to the population covered, benefit models, financing sources, and reimbursement modes.
First, the MIS aims to improve the welfare of pregnant and delivering female workers and covers birth allowance, medical care expenditures, birth subsidies, and maternity leave. This scheme differs from basic health insurance, which covers medical care expenditures for both urban and rural populations.
Second, from the 1950s to the present, the Chinese financing sources have undergone three stages of devel- opment. In Stage 1 (1949–1965), the MIS was supported by the first Chinese national social security policy, “The Labor Insurance Regulation of the Peoplersquo;s Republic of China.” In this policy, the MIS was financed by social insurance funds. In Stage 2 (1965–1987), the MIS was governed by policies published by Chinarsquo;s Ministry of Finance in 1969 [10]. These policies stated that labor insurance funds should not be extracted from state-owned enterprises, and labor insurance spending belongs outside the enterprisersquo;s operation expenses. Since this time, the Chinese
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Front. Med. 2016, 10(4): 473–480 DOI 10.1007/s11684-016-0479-2
RESEARCH ARTICLE
Effect of the new maternity insurance scheme on medical expenditures for caesarean delivery in Wuxi, China:
a retrospective pre/post-reform case study
Chun Chen1,2, Zhihong Cheng3, Ping Jiang3, Mei Sun2, Qi Zhang (✉)4,a, Jun Lv (✉)2,b
1School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China; 2Research Institute of Health Development
Strategies, Fudan University, Shanghai 200032, China; 3Affiliated Hospital, Jiangnan University, Wuxi 214062, China; 4School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA
copy; Higher Education Press and Springer-Verlag Berlin Heidelberg 2016
Abstract Aiming to control rising medical expenditures and help improve Chinarsquo;s healthcare systems, this study
examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitalsrsquo; C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China (2004–2013), and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform. We also used paired sample t-tests and linear regression models to compare the mean medical expenditures between insured and uninsured women undergoing caesarean delivery during the post-reform period. After the schemersquo;s implementation, medical expenditures for caesarean deliveries declined and the medical expenditures of women covered by the scheme were significantly lower than those of uninsured patients. These findings indicated the schemersquo;s effectiveness in minimizing caesarean delivery expenditures. The cap-based medical insurance scheme with shared financial interest between insurance and healthcare providers would likely steer healthcare providersrsquo; behaviors in a more cost-effective direction.
Keywords maternity insurance scheme; financial incentive; caesarean delivery; medical expenditure; China
Introduction
Public hospitals in developing countries, such as China, consume more healthcare resources and have observed rising medical care expenditures compared with preventive and primary healthcare facilities [1]. Therefore, govern- ment agencies at different levels are exploring a feasible public hospital payment method to help reshape the financial incentives of healthcare providers and achieve a cost-effective healthcare system. China, which is under- taking healthcare reform, also formulated health policies to improve public hospitalsrsquo; payment methods at both national and regional levels [2].
The caesarean section (C-section) is a standard surgical procedure that is performed worldwide and annually consumes billions of dollars of healthcare resources [3].
Received February 15, 2016; accepted August 12, 2016 Correspondence: aqzhang@odu.edu; blujun@shmu.edu.cn
Therefore, C-section medical expenditures have received comprehensive attention from scholars and governments worldwide, including China.
Various factors affect the medical expenditures asso- ciated with C-sections, including demographics such as age, income, educational level, insurance status, and clinical conditions [4]; institutional factors such as size, geographical location, and type of institution [5]; and policy factors such as source of payment, malpractice liability, and financial incentives [3].
Additional research on policy factors, such as national or regional insurance schemes, is necessary to reduce financial barriers to obstetric care, particularly in develop- ing or low-income countries [6–9]. Chinarsquo;s national and regional maternity insurance scheme (MIS) is the key policy connecting payment source and financial incentives related to C-section medical expenses. Therefore, more research on the effectiveness of Chinarsquo;s MIS is necessary to control rising medical expenditures and help improve the healthcare systems of other countries or regions.
Chinese MIS
In China, the MIS and basic health insurance schemes are separate yet related, as both are important social insurance schemes and were established through national legislation. However, the MIS has distinct features with regard to the population covered, benefit models, financing sources, and reimbursement modes.
First, the MIS aims to improve the welfare of pregnant and delivering female workers and covers birth allowance, medical care expenditures, birth subsidies, and maternity leave. This scheme differs from basic health insurance, which covers medical care expenditures for both urban and rural populations.
Second, from the 1950s to the present, the Chinese financing sources have undergone three stages of devel- opment. In Stage 1 (1949–1965), the MIS was supported by the first Chinese national social security policy, “The Labor Insurance Regulation of the Peoplersquo;s Republic of China.” In this policy, the MIS was financed by social insurance funds. In Stage 2 (1965–1987), the MIS was governed by policies published by Chinarsquo;s Ministry of Finance in 1969 [10]. These policies stated that labor insurance funds should not be extracted from state-owned enterprises, and labor insurance spending belongs outside the enterprisersquo;s operation expenses. Since this time, the Chinese
全文共31716字，剩余内容已隐藏，支付完成后下载完整资料
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