County Hospital Responses to Funding Reforms in Zhejiang, China: An Interrupted Time-Series Analysis
This study aimed to assess the effects of a two-stage funding reform, involving DRGs-based (Diagnostic Related Groups) payments for inpatient care and capitation funding for outpatient care, respectively, on services volume and care expenditure of county hospitals in Zhejiang province, China. A quas...
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Taylor & Francis Group
2023-12-01
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| Series: | Health Systems & Reform |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/23288604.2023.2258770 |
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| author | Tao Zhang Jing Liu Xiaohe Wang Chaojie Liu |
| author_facet | Tao Zhang Jing Liu Xiaohe Wang Chaojie Liu |
| author_sort | Tao Zhang |
| collection | DOAJ |
| description | This study aimed to assess the effects of a two-stage funding reform, involving DRGs-based (Diagnostic Related Groups) payments for inpatient care and capitation funding for outpatient care, respectively, on services volume and care expenditure of county hospitals in Zhejiang province, China. A quasi-experimental design was adopted, involving 6 hospitals from 2 counties in the intervention group and 12 hospitals from 5 counties in the control group. The DRGs-based payments for inpatient care and capitation funding for outpatient care were introduced in January 2018 and January 2019, respectively. Controlled interrupted time-series analyses were performed to determine the effects of the funding reforms using monthly data over the period from January 2017 to December 2019. The volume of inpatient care decreased after the introduction of the first-stage DRGs-based payments, which was accompanied by an increase in the volume of outpatient visits. The DRGs-based payments led to a reduction of on average 1390 Yuan total expenditure per episode of inpatient care and 1116 Yuan out-of-pocket (OOP) payment per episode of inpatient care. However, the average outpatient expenditure per visit increased. So did the corresponding OOP payment per outpatient visit. The introduction of the second-stage capitation funding for outpatient care reversed the increasing trend of outpatient care. The average expenditure and OOP payment per outpatient visit decreased. The funding reforms create a significant effect on service volumes and expenditures in county hospitals. A coordinated approach to both inpatient and outpatient funding mechanisms is needed to minimize cost-shifting between inpatient and outpatient care and to achieve the intended policy outcomes. |
| format | Article |
| id | doaj-art-d67a80f9f3f54be9bfd16ed76ee55e2e |
| institution | OA Journals |
| issn | 2328-8604 2328-8620 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
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| series | Health Systems & Reform |
| spelling | doaj-art-d67a80f9f3f54be9bfd16ed76ee55e2e2025-08-20T02:31:29ZengTaylor & Francis GroupHealth Systems & Reform2328-86042328-86202023-12-019110.1080/23288604.2023.2258770County Hospital Responses to Funding Reforms in Zhejiang, China: An Interrupted Time-Series AnalysisTao Zhang0Jing Liu1Xiaohe Wang2Chaojie Liu3Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, ChinaAdministrative Office, Yuebei People’s Hospital, Shaoguan, Guangdong, ChinaDepartment of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, ChinaSchool of Psychology and Public Health, La Trobe University, Melbourne, AustraliaThis study aimed to assess the effects of a two-stage funding reform, involving DRGs-based (Diagnostic Related Groups) payments for inpatient care and capitation funding for outpatient care, respectively, on services volume and care expenditure of county hospitals in Zhejiang province, China. A quasi-experimental design was adopted, involving 6 hospitals from 2 counties in the intervention group and 12 hospitals from 5 counties in the control group. The DRGs-based payments for inpatient care and capitation funding for outpatient care were introduced in January 2018 and January 2019, respectively. Controlled interrupted time-series analyses were performed to determine the effects of the funding reforms using monthly data over the period from January 2017 to December 2019. The volume of inpatient care decreased after the introduction of the first-stage DRGs-based payments, which was accompanied by an increase in the volume of outpatient visits. The DRGs-based payments led to a reduction of on average 1390 Yuan total expenditure per episode of inpatient care and 1116 Yuan out-of-pocket (OOP) payment per episode of inpatient care. However, the average outpatient expenditure per visit increased. So did the corresponding OOP payment per outpatient visit. The introduction of the second-stage capitation funding for outpatient care reversed the increasing trend of outpatient care. The average expenditure and OOP payment per outpatient visit decreased. The funding reforms create a significant effect on service volumes and expenditures in county hospitals. A coordinated approach to both inpatient and outpatient funding mechanisms is needed to minimize cost-shifting between inpatient and outpatient care and to achieve the intended policy outcomes.https://www.tandfonline.com/doi/10.1080/23288604.2023.2258770CapitationChinaDRGsinterrupted time series analysespublic hospitals |
| spellingShingle | Tao Zhang Jing Liu Xiaohe Wang Chaojie Liu County Hospital Responses to Funding Reforms in Zhejiang, China: An Interrupted Time-Series Analysis Health Systems & Reform Capitation China DRGs interrupted time series analyses public hospitals |
| title | County Hospital Responses to Funding Reforms in Zhejiang, China: An Interrupted Time-Series Analysis |
| title_full | County Hospital Responses to Funding Reforms in Zhejiang, China: An Interrupted Time-Series Analysis |
| title_fullStr | County Hospital Responses to Funding Reforms in Zhejiang, China: An Interrupted Time-Series Analysis |
| title_full_unstemmed | County Hospital Responses to Funding Reforms in Zhejiang, China: An Interrupted Time-Series Analysis |
| title_short | County Hospital Responses to Funding Reforms in Zhejiang, China: An Interrupted Time-Series Analysis |
| title_sort | county hospital responses to funding reforms in zhejiang china an interrupted time series analysis |
| topic | Capitation China DRGs interrupted time series analyses public hospitals |
| url | https://www.tandfonline.com/doi/10.1080/23288604.2023.2258770 |
| work_keys_str_mv | AT taozhang countyhospitalresponsestofundingreformsinzhejiangchinaaninterruptedtimeseriesanalysis AT jingliu countyhospitalresponsestofundingreformsinzhejiangchinaaninterruptedtimeseriesanalysis AT xiaohewang countyhospitalresponsestofundingreformsinzhejiangchinaaninterruptedtimeseriesanalysis AT chaojieliu countyhospitalresponsestofundingreformsinzhejiangchinaaninterruptedtimeseriesanalysis |