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The effects of patient cost sharing on inpatient utilization, cost, and outcome

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  • Yuan Xu
  • Ning Li
  • Mingshan Lu
  • Elijah Dixon
  • Robert P Myers
  • Rachel J Jelley
  • Hude Quan

Abstract

Background: Health insurance and provider payment reforms all over the world beg a key empirical question: what are the potential impacts of patient cost-sharing on health care utilization, cost and outcomes? The unique health insurance system and rich electronic medical record (EMR) data in China provides us a unique opportunity to study this topic. Methods: Four years (2010 to 2014) of EMR data from one medical center in China were utilized, including 10,858 adult patients with liver diseases. We measured patient cost-sharing using actual reimbursement ratio (RR) which is allowed us to better capture financial incentive than using type of health insurance. A rigorous risk adjustment method was employed with both comorbidities and disease severity measures acting as risk adjustors. Associations between RR and health use, costs and outcome were analyzed by multivariate analyses. Results: After risk adjustment, patients with more generous health insurance coverage (higher RR) were found to have longer hospital stay, higher total cost, higher medication cost, and higher ratio of medication to total cost, as well as higher number and likelihood that specific procedures were performed. Conclusion: Our study implied that patient cost-sharing affects health care services use and cost. This reflects how patients and physicians respond to financial incentives in the current healthcare system in China, and the responses could be a joint effect of both demand and supply side moral hazard. In order to contain cost and improve efficiency in the system, reforming provide payment and insurance scheme is urgently needed.

Suggested Citation

  • Yuan Xu & Ning Li & Mingshan Lu & Elijah Dixon & Robert P Myers & Rachel J Jelley & Hude Quan, 2017. "The effects of patient cost sharing on inpatient utilization, cost, and outcome," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-16, October.
    • Handle: RePEc:plo:pone00:0187096
    DOI: 10.1371/journal.pone.0187096
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    References listed on IDEAS

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    1. Timothy Powell‐Jackson & Winnie Chi‐Man Yip & Wei Han, 2015. "Realigning Demand and Supply Side Incentives to Improve Primary Health Care Seeking in Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 755-772, June.
    2. Rainer Winkelmann, 2004. "Co‐payments for prescription drugs and the demand for doctor visits – Evidence from a natural experiment," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1081-1089, November.
    3. Dahlia K. Remler & Adam J. Atherly, 2003. "Health status and heterogeneity of cost‐sharing responsiveness: how do sick people respond to cost‐sharing?," Health Economics, John Wiley & Sons, Ltd., vol. 12(4), pages 269-280, April.
    4. Devlin, Rose Anne & Sarma, Sisira, 2008. "Do physician remuneration schemes matter? The case of Canadian family physicians," Journal of Health Economics, Elsevier, vol. 27(5), pages 1168-1181, September.
    5. Carine Van De Voorde & Eddy Van Doorslaer & Erik Schokkaert, 2001. "Effects of cost sharing on physician utilization under favourable conditions for supplier‐induced demand," Health Economics, John Wiley & Sons, Ltd., vol. 10(5), pages 457-471, July.
    6. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    7. Suwei Yuan & Yan Liu & Na Li & Yunting Zhang & Zhe Zhang & Jingjing Tao & Lizheng Shi & Hude Quan & Mingshan Lu & Jin Ma, 2014. "Impacts of Health Insurance Benefit Design on Percutaneous Coronary Intervention Use and Inpatient Costs among Patients with Acute Myocardial Infarction in Shanghai, China," PharmacoEconomics, Springer, vol. 32(3), pages 265-275, March.
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