Health insurance and quality and efficiency of medical ... - The Lancet

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Oct 30, 2016 - on the effect of health insurance on quality and efficiency of care in China is ... Medical Insurance (URBMI), the New Rural Cooperative Medical ...
Poster Abstracts

Health insurance and quality and efficiency of medical care for patients with acute myocardial infraction in tertiary hospitals in Shanxi, China: a retrospective study Xiao Jun Lin, Hong Bing Tao, Miao Cai, Zhao Hui Cheng, Man Li Wang, Chang Xu, Hai Feng Lin, Li Jin

Abstract Published Online October 30, 2016 Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China (X Lin PhD, Prof HB Tao PhD, M Cai MS, ZH Cheng PhD, ML Wang PhD, C Xu PhD, HF Lin MS, L Jin MS). Correspondence to: Prof Hongbing Tao, Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology. No. 13 Hangkong Road, Wuhan, Hubei 430030, China [email protected]

Background Previous studies have shown that health insurance type affects patient outcomes, but empirical research on the effect of health insurance on quality and efficiency of care in China is scarce. This study aimed to determine whether there are health insurance-related differences in hospital care for acute myocardial infraction. Methods Patients with a principal diagnosis of acute myocardial infraction were identified from inpatient discharge records of 27 tertiary hospitals in Shanxi, China from September 1, 2013, to October 31, 2014. Patients were classified into four health insurance categories: Urban Employee Basic Medical Insurance (UEBMI), Urban Residents Basic Medical Insurance (URBMI), the New Rural Cooperative Medical Scheme (NCMS), or uninsured (out-of-pocket). The outcomes of interest were in-hospital mortality, length of stay, and total cost. Multilevel logistic regression was applied for in-hospital mortality, and multilevel linear regression for log transformed LOS and total cost. All models were adjusted for patient and hospital characteristics. Limited information from patient medical records was extracted from a database and all records were anonymised. As such, no ethical approval was required for this study. Findings We analysed records for 9075 patients. Compared with UEBMI group, in-hospital mortality was significantly lower for NCMS group (OR 0·613 [95% CI 0·438–0·859]) and uninsured group (0·477 [0·281–0·810]). Excluding patients who died during hospitalisation, compared with UEBMI group length of stay was shorter in the URBMI (coefficient of variable, –0·074 [95% CI –0·115 to –0·034]), NCMS (–0·116 [–0·139 to –0·093]) and uninsured (–0·146 [–0·177 to –0·114]) groups and total cost was lower in the URBMI (–0·067 [–0·130 to –0·004]), NCMS (–0·118 [–0·154 to –0·082]) and uninsured (–0·115 [–0·165 to –0·066]) groups. Interpretation For patients hospitalized for acute myocardial infarction, health insurance type is significantly associated with quality and efficiency of care under current health policies in Shanxi, China. The underlying mechanism justifying this association should be explored further. Funding None. Contributors XJL, HBT, and MC conceived and designed the study, and analysed and interpreted the data. ZHC, MLW, CX, HFL and LJ contributed to data acquisition and provided statistical analysis support. XJL and MC drafted the abstract. All authors have seen and approved the final version of the Abstract for publication. Declaration of interests We declare no competing interests.

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