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Medical insurance payment schemes and patient medical expenses: a cross-sectional study of lung cancer patients in urban China

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机构： [1]School of Management, Beijing University of Chinese Medicine, Beijing,China [2]Medical Device Regulatory Research and Evaluation Center, WestChina Hospital, Sichuan University, Chengdu, China [3]Australian National Instituteof Management and Commerce, Sydney, NSW, Australia [4]Guangdong Institute for International Strategies, Guangdong University of Foreign Studies,Guangzhou, China [5]School of Economics and School of Management, TianjinNormal University, Tianjin, China [6]Newcastle Business School, Universityof Newcastle, Callaghan, NSW, Australia [7]University of Liverpool ManagementSchool, University of Liverpool, Liverpool, UK [8]China Health InsuranceResearch Association, Beijing, China [9]National Institute of Traditional ChineseMedicine Strategy and Development, Beijing University of Chinese Medicine,Beijing, China

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关键词： Payment method Hospital expenses Out-of-pocket expenses Lung cancer

摘要：

As the main cause of cancer death, lung cancer imposes seriously health and economic burdens on individuals, families, and the health system. In China, there is no national study analyzing the hospitalization expenditures of different payment methods by lung cancer inpatients. Based on the 2010-2016 database of insured urban resident lung cancer inpatients from the China Medical Insurance Research Association (CHIRA), this paper aims to investigate the characteristics and cost of hospitalized lung cancer patient, to examine the differences in hospital expenses and patient out-of-pocket (OOP) expenses under four medical insurance payment methods: fee-for-service (FFS), per-diem payments, capitation payments (CAP) and case-based payments, and to explore the medical insurance payment method that can be conducive to controlling the cost of lung cancer.This is a 2010-2016, 7-year cross-sectional study. CHIRA data are not available to researchers after 2016. The Medical Insurance Database of CHIRA was screened using the international disease classification system to yield 28,200 inpatients diagnosed with lung cancer (ICD-10: C34, C34.0, C34.1, C34.2, C34.3, C34.8, C34.9). The study includes descriptive analysis and regression analysis based on generalized linear models (GLM).The average patient age was 63.4 years and the average length of hospital stay (ALOS) was 14.2 day; 60.7% of patients were from tertiary hospitals; and 45% were insured by FFS. The per-diem payment had the lowest hospital expenses (RMB7496.00/US$1176.87), while CAP had the lowest OOP expenses (RMB1328.18/US$208.52). Compared with FFS hospital expenses, per-diem was 21.3% lower (95% CI = -0.265, -0.215) and case-based payment was 8.4% lower (95% CI = -0.151, -0.024). Compared with the FFS, OOP expenses, per-diem payments were 9.2% lower (95% CI = -0.130, -0.063) and CAP was 15.1% lower (95% CI = -0.151, -0.024).For lung cancer patients, per-diem payment generated the lowest hospital expenses, while CAP meant patients bore the lowest OOP costs. Policy makers are suggested to give priority to case-based payments to achieve a tripartite balance among medical insurers, hospitals, and insured members. We also recommend future studies comparing the disparities of various diseases for the cause of different medical insurance schemes.© 2023. The Author(s).

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出版当年[2023]版：

大类 | 3 区医学

小类 | 3 区卫生保健与服务

最新[2023]版：

大类 | 3 区医学

小类 | 3 区卫生保健与服务

第一作者：

第一作者机构： [1]School of Management, Beijing University of Chinese Medicine, Beijing,China

通讯作者：

通讯机构： [1]School of Management, Beijing University of Chinese Medicine, Beijing,China [9]National Institute of Traditional ChineseMedicine Strategy and Development, Beijing University of Chinese Medicine,Beijing, China

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Medical insurance payment schemes and patient medical expenses: a cross-sectional study of lung cancer patients in urban China

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