Improving the performance of social health insurance system through increasing outpatient expenditure reimbursement ratio: a quasi-experimental evaluation study from rural China

• DOI: 10.1186/s12939-018-0799-8
• Publication Date: 2018-06-25T08:17:07Z
• Authors: Yudong Miao; Jianqin Gu; Liang Zhang; Ruibo He; Sandeep Sandeep; Jian Wu
• Keywords: Reimbursement; Health Services Research; Health Economics; Health administration; Social insurance

China has set up a universal coverage social health insurance system since the 2009 healthcare reform. Due to inadequate funds, reimbursed inpatient expenditures with much higher ratio than outpatient expenditure. The gap in reimbursement ratios resulted rapid rising hospitalization rate but poor outcomes among Chinese population. A redistribution of funds become one main challenges for performance Social Health Insurance.Two comparable counties, Dangyang County and Zhijiang County, Hubei Province China, were sampled as intervention group control group, respectively. Insurance Management Department budgeted 600 yuan per capita year patients 3rd stage hypertension cover their expenditures. spending paid out-of-pocket. policies both groups not changed. Besides, 100 patient township physicians hospitals provide management services patients. While, still provided by workers. Propensity Score Matching model Difference-in-differences used estimate net effects dimensions medical utilization, expenditures, SHI reimbursement, outcomes.One thousand, six hundred seventy three pairs taken valid subjects conduct estimation after Matching. effect is increase frequency 3.3 (81.0%) times (P < 0.05), decrease 0.075 (- 60.0%) total service utilization 3.225 (76.8%) 0.05). expenditure decreased 394.2 27.7%) yuan. 90.3 more spending, significantly 282.6 44.0%) 192.3 28.5%) yuan, respectively reduced out-of-pocket 192.8 36.7%) 201.9 29.9%) diastolic blood pressure 2.9 mmHg 0.05) had no significant impact on systolic 7.9 mmHg, P > 0.05).For countries attempting establish expensive might produce good outcomes. Outpatient care chronic diseases should be fundamental, ratio.