Abstract
Purpose Mental disorders affect millions of people with a great economic burden. Guangzhou, a major city in China, initiated the case-based per-episode payment policy for patients with acute mental disorders since 2015.This study aimed to explore whether aggregated payment with per-diem for chronic patients and case-based per-episode for acute patients is more cost-saving than traditional payment with per-diem for both chronic and acute patients.
Methods A total of 6,778 episodes of medical records from Feb 1, 2014 to Feb 1, 2016, including 2,091 patients in one intervention hospital and 4,687 patients in ten control hospitals were extracted from Guangzhou Urban Employee Basic Medical Insurance. Length of stay, number of hospitalization and medical expenditures per year were compared between groups. The total medical expenditures were calculated as sum of medical insurance reimbursement and patient out-of-pocket payments. Economic impact was assessed using propensity score matching (PSM) plus difference-in-differences (DID) method.
Results From governmental health insurance prospective, significant reductions in intervention group were observed in relevant economic outcomes per year per capita, including length of stay reduced 14.11 days (P=0.037), number of hospitalization reduced 0.02 times (P=0.04), medical insurance reimbursement reduced US$439.4 (P=0.017), patient out-of-pocket payments reduced US$242.4 (P<0.01), total medical expenditures reduced US$681.8 (P=0.002).
Conclusions The new payment policy was proved cost-saving and may facilitate acute mental disorder patients’ prognosis.
Keywords
Full Text:
References
Whiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T. The Global Burden of Mental, Neurological and Substance Use Disorders: An Analysis from the Global Burden of Disease Study 2010. Plos One. 2015;10(2).
Organization WH. Health in 2015: From MDGs to SDGs Switzerland: Gov; 2015 [cited 2016 Oct 19th]. Available from: http://www.who.int/gho/publications/mdgs-sdgs/en/
Organization WH. WHO Fact Sheet on Mental Disorders Switzerland: Gov; 2016 [Available from: http://www.who.int/mediacentre/factsheets/fs396/en/.
Feng Y, Xiong XJ, Xue QJ, Yao L, Luo F, Xiang L. The impact of medical insurance policies on the hospitalization services utilization of people with schizophrenia: A case study in Changsha, China. Pak J Med Sci. 2013;29(3):793-8.
Charlson FJ, Baxter AJ, Cheng HG, Shidhaye R, Whiteford HA. The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies. Lancet. 2016;388(10042):376-89.
Baxter AJ, Charlson FJ, Somerville AJ, Whiteford HA. Mental disorders as risk factors: assessing the evidence for the Global Burden of Disease Study. Bmc Med. 2011;9.
Xu JF, Wang J, Wimo A, Qiu CX. The economic burden of mental disorders in China, 2005-2013: implications for health policy. Bmc Psychiatry. 2016;16.
Zhang G. A survey on the healthcare affordability of mental disorders hopitalizated insured patient. Shanghai Arch Psychiatry. 2001;13(1):56-8.
Wang Kun WH, Du Yukai,et al. Analysis on the Modes of Medical Insurance Payment of Mental Health Insititutions Chin J Soc Med,. 2013;30:57-9.
Zheng Hong CQ, Zhao Lijun. Psychiatric hospitals under the new health care health insurance payment and cost control. Journal of Traditional Chinese Medicine Managment. 2013;11:1195-7.
China NHaFPCotPsRo. Implementaion for the clinical pathway of five severe mental disorders including bipolar disorder Beijing: Gov; 2013 [Available from: http://www.moh.gov.cn/zwgkzt/lclj/201306/f33f5a32f2594edd935a758f12752b5d.shtml.
Bureau GS. Statistical communique of Guangzhou on the 2016 economic and social development Guangzhou: Gov; 2017 [Available from: http://data.gzstats.gov.cn/gzStat1/chaxun/njsj.jsp.
Antonakis J, Bendahan S, Jacquart P, Lalive R. On making causal claims: A review and recommendations. Leadership Quart. 2010;21(6):1086-120.
Angrist JD PJ-S. Mostly harmless econometrics: an empiricist's companion. Princeton: Princeton University Press; 2009.
Shen M, Hu M, Sun Z. Assessment of School-Based Quasi-Experimental Nutrition and Food Safety Health Education for Primary School Students in Two Poverty-Stricken Counties of West China. PLoS One. 2015;10(12):e0145090.
Hutchinson PL, Meekers D. Estimating Causal Effects from Family Planning Health Communication Campaigns Using Panel Data: The "Your Health, Your Wealth'' Campaign in Egypt. Plos One. 2012;7(9).
Di Staso M, Gravina GL, Zugaro L, Bonfili P, Gregori L, Franzese P, et al. Treatment of Solitary Painful Osseous Metastases with Radiotherapy, Cryoablation or Combined Therapy: Propensity Matching Analysis in 175 Patients. PLoS One. 2015;10(6):e0129021.
Hammond GC, Croudace TJ, Radhakrishnan M, Lafortune L, Watson A, McMillan-Shields F, et al. Comparative Effectiveness of Cognitive Therapies Delivered Face-to-Face or over the Telephone: An Observational Study Using Propensity Methods. Plos One. 2012;7(9).
Whittaker W, Anselmi L, Kristensen SR, Lau YS, Bailey S, Bower P, et al. Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis. Plos Med. 2016;13(9):e1002113.
Caliendo M, Kopeinig S. Some practical guidance for the implementation of propensity score matching. J Econ Surv. 2008;22(1):31-72.
Leuven E SB. PSMATCH: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing 2003 [Available from: https://ideas.repec.org/c/boc/bocode/s432001.html.
Luo K NC, Dai W, et al. The impact of mixed payment systems in NCMS in Qianjiang of Chongqing. Chin J Hosp Manage. 2007;8:33-4.
Wu G ZY, Liu G, et al. Social benefits from adoption of case-based payment system. Chin J Hosp Manage. 2007;9:26-8.
Yip W, Eggleston K. Provider payment reform in China: the case of hospital reimbursement in Hainan province. Health Econ. 2001;10(4):325-39.
Chen Yao LH, Yu Y,Chen ML,Yao L. The research on the hospitalization expenses controlling effects of the quota for single disease payment in Zhenan county Shaanxi province. Chinese Journal of Health Policy. 2009;2(9):18-23.
Zhou XY WL, Mao ZZ,et al. The analysis of the effect of DRGS in Hepu county of Guangxi province. Mod Prev Med. 2006;33(11):2132-3.
Jian W, Lu M, Chan KY, Poon AN, Han W, Hu M, et al. Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission. Health Aff (Millwood). 2015;34(10):1745-52.
Refbacks
- There are currently no refbacks.
Copyright (c) 2018 Journal of Pharmaceutical and Biomedical Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.