Deregulation and pricing of medical services: a policy experiment based in China

Background Price regulation is a common constraint in Chinese hospitals. Based on a policy experiment conducted in China on the price deregulation of private nonprofit hospitals, this study empirically examines the impact of medical service price regulation on the pricing of medical services by hospitals. Methods Using the claim data of insured inpatients residing in a major Chinese city for the period 2010–2015, this study constructs a DID (difference-in-differences) model to compare the impact of price deregulation on medical expenditure and expenditure structure between public and private nonprofit hospitals. Results The empirical results based on micro data reveal that, price deregulated significantly increased the total expenditure per inpatient visit by 10.5%. In the itemized expenditure, the diagnostic test and drug expenditure per inpatient visit of private nonprofit hospitals decreased significantly, whereas the physician service expenditure per inpatient visit increased significantly. For expenditure structure, the proportions of drug expenditure and diagnostic test expenditure per inpatient visit significantly decreased by 5.7 and 3.1%, respectively. Furthermore, this paper also found that hospitals had larger price changes for dominant diseases than for non-dominant diseases. Conclusions Under price regulation, medical service prices generally become lower than their costs. Therefore, after price deregulation, private nonprofit hospitals increase medical service prices above their cost and achieve the service premium increasing physician medical services. Further, although price deregulation causes patient expenditure to increase to a certain level, it optimizes the expenditure structure, as well.

Cardiometabolic diseases, frailty, and healthcare utilization and expenditure in community-dwelling Chinese older adults

This study investigated associations between cardiometabolic diseases, frailty, and healthcare utilization and expenditure among Chinese older adults. The participants were 5204 community-dwelling adults aged at least 60 years from the China Health and Retirement Longitudinal Study. Five cardiometabolic diseases were assessed including hypertension, dyslipidemia, diabetes, cardiac diseases and stroke. Frailty status was based on five criteria: slowness, weakness, exhaustion, inactivity, and shrinking. Participants were deemed frailty if they met at least three criteria. As the number of cardiometabolic diseases increased, so did the prevalence of frailty, and the proportion of healthcare utilization, including outpatient visit and inpatient visit. Moreover, the total healthcare expenditure and the odds of catastrophic health expenditure were increased with the number of cardiometabolic disorders. After adjusting for covariates, cardiometabolic diseases were positively associated with higher odds of frailty, incurring outpatient and inpatient visit. And individuals with 2 or more cardiometabolic diseases had a higher odds of catastrophic health expenditure than persons with non-cardiometabolic disease. Participants who were frailty were more likely to report higher odds of healthcare utilization. These findings suggest that both cardiometabolic diseases and frailty assessment may improve identification of older adults likely to require costly, extensive healthcare.

Deregulation and pricing of medical services: A policy experiment based in China

Background: Price regulation is a common constraint in Chinese hospitals. Based on a policy experiment conducted in China on the price deregulation of private nonprofit hospitals, this study empirically examines the impact of medical service price regulation on the pricing of medical services by hospitals. Methods: Using the claim data of insured inpatients residing in a major Chinese city for the period 2010–2015, this study constructs a DID (difference-in-differences) model to compare the impact of price deregulation on medical expenditure and expenditure structure between public and private nonprofit hospitals. Results: The empirical results based on micro data reveal that, price deregulated significantly increased the total expenditure per inpatient visit by 10.5%. In the itemized expenditure, the diagnostic test and drug expenditure per inpatient visit of private nonprofit hospitals decreased significantly, whereas the physician service expenditure per inpatient visit increased significantly. For expenditure structure, the proportions of drug expenditure and diagnostic test expenditure per inpatient visit significantly decreased by 5.7% and 3.1%, respectively. Conclusions: Under price regulation, medical service prices generally become lower than their costs. Therefore, after price deregulation, private nonprofit hospitals increase medical service prices above their cost and achieve the service premium by providing high-quality medical services and a comfortable medical environment. Further, although price deregulation causes patient expenditure to increase to a certain level, it optimizes the expenditure structure, as well.

Deregulation and pricing of medical services A policy experiment based in China

Background: Price regulation is a common constraint in Chinese hospitals. Based on a policy experiment conducted in China on the price deregulation of private nonprofit hospitals, this study empirically examines the impact of medical service price regulation on the pricing of medical services by hospitals. Methods: Using the claim data of insured inpatients residing in a major Chinese city for the period 2010–2015, this study constructs a DID (difference-in-differences) model to compare the impact of price deregulation on medical expenditure and expenditure structure between for-profit and nonprofit hospitals. Results: The empirical results based on micro data reveal that, price deregulated significantly increased the total expenditure per inpatient visit by 10.5%. In the itemized expenditure, the diagnostic test and drug expenditure per inpatient visit of private nonprofit hospitals decreased significantly, whereas the physician service expenditure per inpatient visit increased significantly. For expenditure structure, the proportions of drug expenditure and diagnostic test expenditure per inpatient visit significantly decreased by 5.7% and 3.1%, respectively. Conclusions: Under price regulation, medical service prices generally become lower than their costs. Therefore, after price deregulation, private nonprofit hospitals increase medical service prices above their cost and achieve the service premium by providing high-quality medical services and a comfortable medical environment. Further, although price deregulation causes patient expenditure to increase to a certain level, it optimizes the expenditure structure, as well.

Urban and Rural Disparities in Healthcare Utilization and Expenditures Among Rural Hukou Beneficiaries of New Cooperative Medical Scheme in China

Background The New Cooperative Medical Scheme (NCMS) is a social health insurance available to rural Chinese residents. Over time, several concerns to this system have been raised, including disparities among healthcare utilization and expenditures. Most studies only discuss disparities in general in NCMS, with few studies concentrating on comparing disparities between urban and rural regions. Moreover, this issue has an increasing importance due to the rapid population growth of rural migrants. Therefore, we conducted our study to explore urban and rural disparities among NCMS beneficiaries.Methods Our study is based on Chinese Health and Retirement Longitudinal Study (CHARLS) for 2015. Our targeted sample is individuals with rural hukou and only covered by NCMS. We define and use influential factors in our logistic regressions and descriptive tables to compare urban and rural disparities among these NCMS beneficiaries. Results In terms of inpatient care, urban beneficiaries have a lower probability (OR=1.013, P=0.892) and frequency (1.39 vs. 1.47, P=0.131) of having an inpatient visit than rural beneficiaries. However, urban beneficiaries have higher out-of-pocket (OOP) expenditures among inpatient visit (￥6788.98 vs. ￥6163.92, P=0.470) and medicine (￥3907.30 vs. ￥2649.67, P<0.01). In addition, urban beneficiaries were found to have higher reimbursement of inpatient visit (￥4457.66 vs. ￥4127.83, P<0.001) and medicine (￥2466.93 vs. ￥1774.55, P<0.05). In terms of outpatient care, urban beneficiaries have less possibility (OR=1.074, P=0.384) and frequency (2.15 vs. 2.26, P=0.225) of an outpatient visit than rural beneficiaries. Moreover, compared to rural beneficiaries, urban beneficiaries have less out-of-pocket (OOP) expenditures of outpatient visit (￥709.80 vs. ￥ 710.98, P=0.608) and drugs (￥448.68 vs. ￥ 522.95, P=0.645), and less reimbursement of outpatient visit (￥296.03 vs. ￥ 344.51, P=0.808) and drugs (￥99.25 vs. ￥ 114.60, P<0.05).Conclusion In terms of healthcare utilization, rural beneficiaries have both higher probability and frequency of inpatient and outpatient visits. In terms of healthcare expenditures, urban beneficiaries get more inpatient reimbursement with higher inpatient expenditures, while rural beneficiaries get more outpatient reimbursement with higher outpatient expenditures. Both situations have not solid answer yet, and therefore require further research.