scholarly journals Health care utilization for patients with stroke: a 3-year cross-sectional study of China’s two urban health insurance schemes across four cities

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yong Yang ◽  
Stephen Nicholas ◽  
Shuo Li ◽  
Zhengwei Huang ◽  
Xiaoping Chen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Length Of Stay ◽  
Health Care Utilization ◽  
Medical Costs ◽  
Care Utilization ◽  
Stroke Patients ◽  
Basic Medical Insurance ◽  
Insurance Type ◽  
Basic Medical

Abstract Background Stroke is a devastating disease and a major cause of death and disability in China. While existing studies focused mainly on differences in stroke patients’ health care utilization by insurance type, this study assesses whether health utilization and medical costs differed by insurance type across four cities in China. Methods A 5% random sample from the 2014–2016 China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) claims data were collected across four cities, Beijing, Shanghai, Tianjin, and Chongqing. Descriptive statistics and ordinary least squares regression were employed to analyze the data. Results We found that differences in healthcare utilization and inpatient and outpatient medical expenses varied more by city-specific insurance type than they did between the UEBMI and URBMI schemes. For example, the median UEBMI medical outpatient costs in Beijing (RMB500.2) were significantly higher than UEBMI patients in Shanghai (RMB260.8), Tianjin (RMB240.8), and Chongqing (RMB293.0), and Beijing URBMI patients had significantly higher outpatient medical costs (RMB356.9) than URBMI patients in Shanghai (RMB233.4) and Chongqing (RMB211.0), which were significantly higher than Tianjin (RMB156.2). Patients in Chongqing had 66.4% (95% CI: − 0.672, − 0.649) fewer outpatient visits, 13.0% (95% CI: − 0.144, − 0.115) fewer inpatient visits, and 34.2% (95% CI: − 0.366, − 0.318) shorter length of stay than patients in Beijing. The divergence of average length of stay and out-of-pocket (OOP) expenses by insurance type was also greater between cities than the UEMBI-URBMI mean difference. Conclusions Significant city-specific differences in stroke patients’ healthcare utilization and medical costs reflected inequalities in health care access. The fragmented social health insurance schemes in China should be consolidated to provide patients in different cities equal financial protection and benefit packages and to improve the equity of stroke patient access to health care.

scholarly journals Health care utilization for patients with stroke: A 3-year cross-sectional study of China’s two urban health insurance schemes across four cities

2020 ◽  
Author(s):  
Yong Yang ◽  
Stephen Nicholas ◽  
Shuo Li ◽  
Zhengwei Huang ◽  
Xiaoping Chen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Healthcare Utilization ◽  
Average Length ◽  
Medical Insurance ◽  
Medical Costs ◽  
Care Utilization ◽  
Basic Medical Insurance ◽  
Insurance Type ◽  
Basic Medical

Abstract Background Stroke is a devastating disease and a major cause of death and disability worldwide. We evaluated differences in stroke patients’ health care utilization by insurance type across four cities in China. Methods The data were a 5% random sampling from claims data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) from 2014 to 2016. The descriptive analyze and interaction actions were mainly conducted. Results We found that differences in healthcare utilization and medical expenses varied more across the four cities, Beijing, Shanghai, Tianjin, and Chongqing, than they did between the UEBMI and URBMI scheme. On average, UEBMI patients had a significantly larger number of outpatient (4.3) and inpatient (1.4) visits per year than the URBMI group (2.0 outpatient and 1.1 inpatient visits per year). UEBMI members’ average length of stay (ALOS) of 18.3 days was significantly longer than the 11 days ALOS of URBMI members. Importantly, the significant differences in healthcare utilization and healthcare expenditures were greater between cities than the average differences between UEBMI and URBMI. Beijing UEBMI outpatient (5.0) and inpatient (1.4) visits and Shanghai UEBMI outpatient (4.8) and inpatient (1.7) visits were significantly higher than Tianjin (3.4 outpatient and 1.4 inpatient visits) and Chongqing (1.8 outpatient and 1.1 inpatient visits). The divergences of UEBMI visits across the four cities were greater than the average UEBMI outpatient (4.3) and inpatient (1.4) visits. ALOS for URBMI Beijing patients (14.8 days) and Shanghai patients (27.7 days) were significantly longer than Tianjin (10.2 days) and Chongqing (10.1 days) URBMI patients. Medical costs, total OOP expenses and OOP reimbursement rates also varied more across the four cities than the average UEBMI or URBMI medical costs, total OOP expenses and reimbursement rates. Conclusions The health care utilization of patients with stroke varied by insurance type and city, and the differences in utilization and health care costs across cities was greater than the average difference between UEBMI and URBMI. Launching a new critical illness insurance scheme and further reforming the UEBMI and URBMI schemes would reduce these inter-city differences in health care utilization.

scholarly journals Effects of health insurance integration on health care utilization and its equity among the mid-aged and elderly: evidence from China

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Chaofan Li ◽  
Chengxiang Tang ◽  
Haipeng Wang
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Utilization ◽  
Concentration Index ◽  
Care Utilization ◽  
Control Group ◽  
Positive Effects ◽  
Basic Medical Insurance ◽  
Outpatient Visits ◽  
Basic Medical

Abstract Background The fragmentation of health insurance schemes in China has undermined equity in access to health care. To achieve universal health coverage by 2020, the Chinese government has decided to consolidate three basic medical insurance schemes. This study aims to evaluate the effects of integrating Urban and Rural Residents Basic Medical Insurance schemes on health care utilization and its equity in China. Methods The data for the years before (2013) and after (2015) the integration were obtained from the China Health and Retirement Longitudinal Study. Respondents in pilot provinces were considered as the treatment group, and those in other provinces were the control group. Difference-in-difference method was used to examine integration effects on probability and frequency of health care visits. Subgroup analysis across regions of residence (urban/rural) and income groups and concentration index were used to examine effects on equity in utilization. Results The integration had no significant effects on probability of outpatient visits (β = 0.01, P > 0.05), inpatient visits (β = 0.01, P > 0.05), and unmet hospitalization needs (β =0.01, P > 0.05), while it had significant and positive effects on number of outpatient visits (β = 0.62, P < 0.05) and inpatient visits (β = 0.39, P < 0.01). Moreover, the integration had significant and positive effects on number of outpatient visits (β = 0.77, P < 0.05) and inpatient visits (β = 0.49, P < 0.01) for rural residents but no significant effects for urban residents. Furthermore, the integration led to an increase in the frequency of inpatient care utilization for the poor (β = 0.78, P < 0.05) among the piloted provinces but had no significant effects for the rich (β = 0.25, P > 0.05). The concentration index for frequency of inpatient visits turned into negative direction in integration group, while that in control group increased by 0.011. Conclusions The findings suggest that the integration of fragmented health insurance schemes could promote access to and improve equity in health care utilization. Successful experiences of consolidating health insurance schemes in pilot provinces can provide valuable lessons for other provinces in China and other countries with similar fragmented schemes.

scholarly journals A Comparison Between Subjective and Objective Methods of Predicting Health Care Expenses to Support Consumers’ Health Insurance Plan Choice

2018 ◽  
Vol 3 (1) ◽  
pp. 238146831878109 ◽  
Author(s):  
Mary C. Politi ◽  
Enbal Shacham ◽  
Abigail R. Barker ◽  
Nerissa George ◽  
Nageen Mir ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Utilization ◽  
Subjective Health ◽  
Care Utilization ◽  
Insurance Plan ◽  
Health Insurance Plan ◽  
Subjective Health Status ◽  
Reported Health ◽  
Nationally Representative

Objective. Numerous electronic tools help consumers select health insurance plans based on their estimated health care utilization. However, the best way to personalize these tools is unknown. The purpose of this study was to compare two common methods of personalizing health insurance plan displays: 1) quantitative healthcare utilization predictions using nationally representative Medical Expenditure Panel Survey (MEPS) data and 2) subjective-health status predictions. We also explored their relations to self-reported health care utilization. Methods. Secondary data analysis was conducted with responses from 327 adults under age 65 considering health insurance enrollment in the Affordable Care Act (ACA) marketplace. Participants were asked to report their subjective health, health conditions, and demographic information. MEPS data were used to estimate predicted annual expenditures based on age, gender, and reported health conditions. Self-reported health care utilization was obtained for 120 participants at a 1-year follow-up. Results. MEPS-based predictions and subjective-health status were related ( P < 0.0001). However, MEPS-predicted ranges within subjective-health categories were large. Subjective health was a less reliable predictor of expenses among older adults (age × subjective health, P = 0.04). Neither significantly related to subsequent self-reported health care utilization ( P = 0.18, P = 0.92, respectively). Conclusions. Because MEPS data are nationally representative, they may approximate utilization better than subjective health, particularly among older adults. However, approximating health care utilization is difficult, especially among newly insured. Findings have implications for health insurance decision support tools that personalize plan displays based on cost estimates.

scholarly journals Health Status, Health Insurance, and Health Care Utilization Patterns of Immigrant Black Men

2003 ◽  
Vol 93 (10) ◽  
pp. 1740-1747 ◽  
Author(s):  
Jacqueline W. Lucas ◽  
Daheia J. Barr-Anderson ◽  
Raynard S. Kington
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Status ◽  
Health Care Utilization ◽  
Black Men ◽  
Care Utilization ◽  
Utilization Patterns

scholarly journals Pediatric abusive head trauma and stroke

2017 ◽  
Vol 20 (2) ◽  
pp. 183-190 ◽  
Author(s):  
Nickalus R. Khan ◽  
Brittany D. Fraser ◽  
Vincent Nguyen ◽  
Kenneth Moore ◽  
Scott Boop ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Head Trauma ◽  
Abusive Head Trauma ◽  
Hospital Charges ◽  
Care Utilization ◽  
Stroke Patients ◽  
Grade Ii ◽  
Neurosurgical Intervention ◽  
Grade Iii

OBJECTIVEDespite established risk factors, abusive head trauma (AHT) continues to plague our communities. Cerebrovascular accident (CVA), depicted as areas of hypodensity on CT scans or diffusion restriction on MR images, is a well-known consequence of AHT, but its etiology remains elusive. The authors hypothesize that a CVA, in isolation or in conjunction with other intracranial injuries, compounds the severity of a child’s injury, which in turn leads to greater health care utilization, including surgical services, and an increased risk of death.METHODSThe authors conducted a retrospective observational study to evaluate data obtained in all children with AHT who presented to Le Bonheur Children’s Hospital (LBCH) from January 2009 through August 2016. Demographic, hospital course, radiological, cost, and readmission information was collected. Children with one or more CVA were compared with those without a CVA.RESULTSThe authors identified 282 children with AHT, of whom 79 (28%) had one or more CVA. Compared with individuals without a CVA, children with a stroke were of similar overall age (6 months), sex (61% male), and race (56% African-American) and had similar insurance status (81% public). Just under half of all children with a stroke (38/79, 48%) were between 1–6 months of age. Thirty-five stroke patients (44%) had a Grade II injury, and 44 (56%) had a Grade III injury. The majority of stroke cases were bilateral (78%), multifocal (85%), associated with an overlying subdural hematoma (86%), and were watershed/hypoperfusion in morphology (73%). Thirty-six children (46%) had a hemispheric stroke. There were a total of 48 neurosurgical procedures performed on 28 stroke patients. Overall median hospital length of stay (11 vs 3 days), total hospital charges ($13.8 vs $6.6 million), and mean charges per patient ($174,700 vs $32,500) were significantly higher in the stroke cohort as a whole, as well as by injury grade (II and III). Twenty children in the stroke cohort (25%) died as a direct result of their AHT, whereas only 2 children in the nonstroke cohort died (1%). There was a 30% readmission rate within the first 180-day postinjury period for patients in the stroke cohort, and of these, approximately 50% required additional neurosurgical intervention(s).CONCLUSIONSOne or more strokes in a child with AHT indicate a particularly severe injury. These children have longer hospital stays, greater hospital charges, and a greater likelihood of needing a neurosurgical intervention (i.e., bedside procedure or surgery). Stroke is such an important predictor of health care utilization and outcome that it warrants a subcategory for both Grade II and Grade III injuries. It should be noted that the word “stroke” or “CVA” should not automatically imply arterial compromise in this population.

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