Comparison of Chinese inpatients with different types of medical insurance before and after the 2009 healthcare reform

Abstract

BACKGROUND: Since 1994, China has established three major basic medical insurance (MI) schemes that aim to provide greater financial protection to members. The 2009 Chinese medical reform emphasized the enhancement of basic medical insurance. This study aims to investigate changes in hospital services costs for inpatients with different types of MI before and after the new Chinese medical reform. METHODS: A total of 532,120 inpatient medical records, completed by 11 different hospitals nationwide in 2008 and 2011, were collected from the Ministry of Health retrospectively. Median and mean values were calculated to describe costs and average length of stay, respectively. A chi-square test was used to compare the distribution of patient visits. Wilcoxon rank-sum tests were conducted to compare costs. RESULTS: The number of patients hospitalized increased. The average cost per stay in the three basic MI schemes increased, while out-of-pocket (OOP) spending decreased (P < 0.0001). The average cost per day showed similar trends. The purchase of Western medication accounted for the largest proportion of costs in all MI schemes in both years; however, these ratios decreased from 2008 to 2011, while those for other social insurance and OOP patients almost doubled. The average length of stay remained unchanged, and the average lengths of stay in the MI schemes differed before and after the healthcare reform. CONCLUSIONS: Healthcare reform with multipartite policies may make interactional impacts on hospitalization services for patients enrolled in MI schemes.