Effect of the new maternity insurance scheme on medical expenditures for caesarean delivery in Wuxi, China: a retrospective pre/post-reform case study

Abstract

Aiming to control rising medical expenditures and help improve China’s healthcare systems, this study examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitals’ C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China (2004–2013), and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform. We also used paired sample t-tests and linear regression models to compare the mean medical expenditures between insured and uninsured women undergoing caesarean delivery during the post-reform period. After the scheme’s implementation, medical expenditures for caesarean deliveries declined and the medical expenditures of women covered by the scheme were significantly lower than those of uninsured patients. These findings indicated the scheme’s effectiveness in minimizing caesarean delivery expenditures. The cap-based medical insurance scheme with shared financial interest between insurance and healthcare providers would likely steer healthcare providers’ behaviors in a more cost-effective direction.

Keywords

maternity insurance scheme / financial incentive / caesarean delivery / medical expenditure / China

References

[1] Yip WCM, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China’s huge and complex health-care reforms. Lancet 2012; 379(9818): 833–842

[2] Chen C, Dong W, Shen JJ, Cochran C, Wang Y, Hao M. Is the prescribing behavior of Chinese physicians driven by financial incentives? Soc Sci Med 2014; 120: 40–48

[3] Grant D. Physician financial incentives and cesarean delivery: new conclusions from the healthcare cost and utilization project. J Health Econ 2009; 28(1): 244–250

[4] Tsai YW, Hu TW. National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan. Am J Public Health 2002; 92(9): 1514–1517

[5] Río I, Castelló A, Barona C, Jané M, Más R, Rebagliato M, Bosch S, Martínez E, Bolúmar F. Caesarean section rates in immigrant and native women in Spain: the importance of geographical origin and type of hospital for delivery. Eur J Public Health 2010; 20(5): 524–529

[6] Adinma ED, Nwakoby BA, Adinma BD. Integrating maternal health services into a health insurance scheme: effect on healthcare delivery. Nig Q J Hosp Med 2010; 20(2): 86–93

[7] Criel B, Van der Stuyft P, Van Lerberghe W. The Bwamanda hospital insurance scheme: effective for whom? A study of its impact on hospital utilization patterns. Soc Sci Med 1999; 48(7): 897–911

[8] Mensah J, Oppong JR, Schmidt CM. Ghana’s National Health Insurance Scheme in the context of the health MDGs: an empirical evaluation using propensity score matching. Health Econ 2010; 19(S1 Suppl): 95–106

[9] Richard F, Witter S, de Brouwere V. Innovative approaches to reducing financial barriers to obstetric care in low-income countries. Am J Public Health 2010; 100(10): 1845–1852

[10] West LA. Pension reform in China: preparing for the future. J Dev Stud 1999; 35(3): 153–183

[11] Bogg L, Wang K, Diwan V. Chinese maternal health in adjustment: claim for life. Reprod Health Matters 2002; 10(20): 95–107

[12] Ramesh M, Wu X. Health policy reform in China: lessons from Asia. Soc Sci Med 2009; 68(12): 2256–2262

[13] Feldman R. The economics of provider payment reform: are accountable care organizations the answer? J Health Polit Policy Law 2015; 40(4): 745–760

[14] Wuxi Statistic Bureau. Wuxi Statistical Yearbook (Wuxi Tong Ji Nian Jian). Beijing: China Statistics Press, 2014 (in Chinese)

[15] Richardson JR, Peacock SJ. Supplier-induced demand: reconsidering the theories and new Australian evidence. Appl Health Econ Health Policy 2006; 5(2): 87–98

[16] Blaug M. Where are we now in British health economics? Health Econ 1998; 7(S1 Suppl 1): S63–S78

[17] Ren Y. Community Health Service. Dalian: Liaoning Science and Technology Press, 2011

[18] Wuxi Statistic Bureau. Wuxi Statistical Yearbook (Wuxi Tong Ji Nian Jian). Beijing: China Statistics Press, 2013 (in Chinese)

[19] Wuxi Statistic Bureau. A Briefing on the Development of Wuxi’s Economy in 2013 (2013 Wuxi Guo Ming Jing Ji She Hui Fa Zhan Tong Ji Gong Bao). http://www.stats-sh.gov.cn/fxbg/201406/270679.html. Wuxi Statistic Bureau, 2014 (in Chinese)

[20] Wang H, Xu T, Xu J. Factors contributing to high costs and inequality in China’s health care system. JAMA 2007; 298(16): 1928–1930

[21] Zhang P. Disscuss on the expense of cesarean delivery. China Pract Med (Zhongguo Shi Yong Yi Yao) 2010; 5: 257–258 (in Chinese)

[22] Ma X, Qi L. Grey analysis of the causes of single disease hospitalization expenses increase in the hospital. Chin Health Econ (Zhongguo Wei Sheng Jing Ji) 2011; 30: 71 (in Chinese)

[23] Guterman S, Davis K, Schoenbaum S, Shih A. Using Medicare payment policy to transform the health system: a framework for improving performance. Health Aff (Millwood) 2009; 28(2): w238–w250

Acknowledgements

We are indebted to the doctors and staff at the Affiliated Hospital of Jiangnan University for their contributions. This study was funded by National Natural Science Foundation of China (Nos. 71373051, 71403056, and 71603187), Zhejiang Provincial Natural Science Foundation (No. LQ16G030011), and the Key Social Science Project for University Teachers of Zhejiang, China (No. 2014QN005).

Compliance with ethics guidelines

Chun Chen, Zhihong Cheng, Ping Jiang, Mei Sun, Qi Zhang, and Jun Lv declare that they have no conflict of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. The Fudan University Research Ethics Committee provided ethical approval for this study (No. IRB#2013-03-0416).

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2016 Higher Education Press and Springer-Verlag Berlin Heidelberg