Interrupted time series analysis of the impact of integrated health insurance on out-of-pocket hospitalization costs for catastrophic illness

Research area

The examine was performed in Jiujiang, within the Chinese language province of Jiangxi, which is in southern China. The town has ten counties with a inhabitants of 4 million. Previous to 2016, sufferers lined by NCMS have reimbursed all prices (together with catastrophic medical insurance coverage) previous to discharge¹⁸. As of 2016, the city and rural built-in medical insurance coverage was carried out¹⁹. As well as, since October 2017, metropolis sufferers have been reimbursed for all advantages beneath a “single immediate reimbursement plan” previous to discharge, together with primary medical health insurance advantages, catastrophic medical health insurance, supplemental medical health insurance for impoverished populations and medical help from the Workplace of Civil Affairs^twenty. As well as, the native authorities attracts at least 5% from the Catastrophic Medical Insurance coverage Pool, which is meant to supply extra reimbursement for prime medical bills.^twenty-one. The catastrophic medical health insurance deductible is set as 50% of Jiujiang per capita disposable revenue, the reimbursement price is 60%. The principle variations and adjustments between NCMS and URRBMI in Jiujiang are listed in Desk 1^22,23,24.25.

On this examine, we selected one tertiary hospital out of six tertiary hospitals for evaluation. The chosen hospital was one of many largest hospitals with greater than 1,500 beds.

Knowledge administration

The information was retrieved from the hospital info system, which contained info on all sufferers recognized with catastrophic sickness admitted from January 2014 to December 2018. Catastrophic sickness included the next 20 diseases and was lined by each URRBMI and by the Catastrophic Sickness Medical Insurance coverage: acute myocardial infarction, breast most cancers, cerebral infarction, cervical most cancers, power myelogenous leukemia, cleft lip and palate, colon most cancers, colorectal most cancers, end-stage renal illness, esophageal most cancers, gastric most cancers, hemophilia, opportunistic HIV an infection, hyperthyroidism, hypospadias, lung most cancers, thalassemia, multidrug-resistant tuberculosis, extreme psychological sickness, and kind I diabetes¹⁹.

The R package deal “tidyverse” was used for knowledge cleansing. The 5-year knowledge was mixed in a single file. Twenty catastrophic diseases have been chosen by matching the primary analysis with the ICD-10 code. The variables chosen for the examine included sociodemographic traits, size of keep, ICD-10 analysis, insurance coverage, and medical bills. For medical bills, outliers and lacking knowledge have been explored. Full instances have been included within the remaining knowledge. China’s shopper worth index (CPI) from 2014 to 2018 was obtained from the World Financial institution²⁶. All medical prices have been standardized by the CPI, taking the yr 2014 as a reference.

Knowledge evaluation

Interrupted Time Sequence Evaluation (ITSA) was used to research the results of integration. ITSA is taken into account a strong quasi-experimental method when management teams are lacking. In interrupted time sequence research, segmented regression evaluation has been proven to be efficient in estimating intervention results.^27,28.29. On this examine, the mannequin was constructed as follows:

the place Y is the dependent variable representing the share discount in out-of-pocket hospitalization price per capita, the overall hospitalization price per capita, and the common reimbursement price. Time, integration, and time after integration have been thought-about the impartial variables. Time referred to every month from January 2014 to December 2018. Integration was assigned 0 earlier than integration (January 2014 to December 2015) and one after integration (January 2016 to December 2018). Time after integration was assigned 0 earlier than integration and elevated month-to-month after integration (as a result of there have been 24 months earlier than integration and 36 months after integration, the worth of this variable after integration is about from 25 to 60). β₀ is the extent of the variables defined initially. β₁ estimates the baseline development earlier than integration. β_two estimates the impact of integration on the change in intercept. β₃ displays the change in development after integration (the change in slope). ε is the error time period. All statistical analyzes have been carried out utilizing R software program model 3.5.2. The R package deal “Wats” and “nlme” have been used for ITSA, “ggplot2” was used to create the plots.

Ethics Statements

The examine was performed in accordance with the rules of the Declaration of Helsinki and was authorised by the Ethics Committee of Jiujiang College (REC: JJU20160116).

The Jiujiang College Ethics Committee waived affected person consent as a result of this examine solely concerned anonymized publicly accessible secondary knowledge.