Association between health insurance cost-sharing and choice of hospital tier for cardiovascular diseases in China: a prospective cohort study

• DOI: 10.1016/j.lanwpc.2024.101020
• Publication Date: 2024-02-14T14:23:47Z
• Authors: Muriel Levy; John Buckell; Robert Clarke; Nina Wu; Pei Pei; Dianjianyi Sun; Daniel Avery; Hua Zhang; Jun Lv; Canqing Yu; Liming Li; Zhengming Chen; Winnie Yip; Yiping Chen; Borislava Mihaylova; Junshi Chen; Zhengming Chen; Robert Clarke; Rory Collins; Liming Li; Chen Wang; Jun Lv; Richard Peto; Robin Walters; Daniel Avery; Maxim Barnard; Derrick Bennett; Ruth Boxall; Kahung Chan; Yiping Chen; Zhengming Chen; Johnathan Clarke; Robert Clarke; Huaidong Du; Ahmed Edris Mohamed; Hannah Fry; Simon Gilbert; Pek Kei Im; Andri Iona; Maria Kakkoura; Christiana Kartso...; Hubert Lam; Kuang Lin; James Liu; Mohsen Mazidi; Iona Millwood; Sam Morris; Qunhua Nie; Alfred Pozaricki; Paul Ryder; Saredo Said; Dan Schmidt; Becky Stevens; Iain Turnbull; Robin Walters; Baihan Wang; Lin Wang; Neil Wright; Ling Yang; Xiaoming Yang; Pang Yao; Xiao Han; Can Hou; Qingmei Xia; Chao Liu; Jun Lv; Pei Pei; Dianjianyi Sun; Canqing Yu; Naying Chen; Duo Liu; Zhenzhu Tang; Ningyu Chen; Qilian Jiang; Jian Lan; Mingqiang Li; Yun Liu; Fanwen Meng; Jinhuai Meng; Rong Pan; Yulu Qin; Ping Wang; Sisi Wang; Liuping Wei; Liyuan Zhou; Caixia Dong; Pengfei Ge; Xiaolan Ren; Zhongxiao Li; Enke Mao; Tao Wang; Hui Zhang; Xi Zhang; Jinyan Chen; Ximin Hu; Xiaohuan Wang; Zhendong Guo; Huimei Li; Yilei Li; Min Weng; Shukuan Wu; Shichun Yan; Mingyuan Zou; Xue Zhou; Ziyan Guo; Quan Kang; Yanjie Li; Bo Yu; Qinai Xu; Liang Chang; Lei Fan; Shixian Feng; Ding Zhang; Gang Zhou; Yulian Gao; Tianyou He; Pan He; Chen Hu; Huarong Sun; Xukui Zhang; Biyun Chen; Zhongxi Fu; Yuelong Huang; Huilin Liu; Qiaohua Xu; Li Yin; Huajun Long; Xin Xu; Hao Zhang; Libo Zhang; Jian Su; Ran Tao; Ming Wu; Jie Yang; Jinyi Zhou; Yonglin Zhou; Yihe Hu; Yujie Hua; Jianrong Jin; Fang Liu; Jingchao Liu; Yan Lu; Liangcai Ma; Aiyu Tang; Jun Zhang; Liang Cheng; Ranran Du; Ruqin Gao; Feifei Li; Shanpeng Li; Yongmei Liu; Feng Ning; Zengchang Pang; Xiaohui Sun; Xiaocao Tian; Shaojie Wang; Yaoming Zhai; Hua Zhang; Wei Hou; Silu Lv; Junzheng Wang; Xiaofang Chen; Xianping Wu; Ningmei Zhang; Xiaoyu Chang; Xiaofang Chen; Jianguo Li; Jiaqiu Liu; Guojin Luo; Qiang Sun; Xunfu Zhong; Weiwei Gong; Ruying Hu; Hao Wang; Meng Wang; Min Yu; Lingli Chen; Qijun Gu; Dongxia Pan; Chunmei Wang; Kaixu Xie; Xiaoyi Zhang; Hongyuan Chen; Liyang Liu; Haiyan Gou; Xun Wang; Jing Ding; Ning Zhang; Yueshi Mao; Shanshan Zhou; Lirong Jin; Xin Cheng; Yun Lu; Li Chen; Zilong Hao; Xiaona Xing; Lei Wang; Naixin Ju; Yiting Mao; Shuya Li; Peng Du; Deren Wang; Xiaojia Sun; Shihao You; Weizhi Wang; Yanmei Zhu; Xiaojiu Li; Yi Dong
• Keywords: Reimbursement; Cost sharing; Overcrowding; Stroke

BackgroundHospitals in China are classified into tiers (1, 2 or 3), with the largest (tier 3) having more equipment and specialist staff. Differential health insurance cost-sharing by hospital tier (lower deductibles higher reimbursement rates lower tiers) was introduced to reduce overcrowding hospitals, promote use of limit escalating healthcare costs. However, little is known about effects differential schemes on choice tiers.MethodsIn a 9-year follow-up prospective study 0.5 M adults from 10 areas China, we examined associations between for patients first hospitalisation stroke ischaemic heart disease (IHD) 2009–2017. Analyses were performed separately urban (stroke: n = 20,302; IHD: 19,283) rural 21,130; 17,890), using conditional logit models adjusting individual socioeconomic characteristics.FindingsAbout 64–68% IHD cases 27–29% chose 3 hospitals. In areas, each associated greater likelihood choosing their respective tiers. modest, suggesting contribution other factors. Higher status severity seeking care hospitals areas.InterpretationPatient treatment influenced but not areas. Further strategies required incentivise appropriate behaviour efficient use.FundingWellcome Trust, Medical Research Council, British Heart Foundation, Cancer UK, Kadoorie Charitable Ministry Science Technology, National Natural Foundation China.