Impact of Critical Illness Insurance on the Burden of High-Cost Rural Residents in Central China: An Interrupted Time Series Study

Lu Li, Junnan Jiang, Li Xiang, Xuefeng Wang, Li Zeng and Zhengdong Zhong
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Lu Li: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China
Junnan Jiang: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China
Li Xiang: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China
Xuefeng Wang: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China
Li Zeng: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China
Zhengdong Zhong: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan 430030, China

IJERPH, 2019, vol. 16, issue 19, 1-11

Abstract: Critical illness insurance (CII) in China was introduced to protect high-cost groups from health expenditure shocks for the purpose of mutual aid. This study aimed to evaluate the impact of CII on the burden of high-cost groups in central rural China. Data were extracted from the basic medical insurance (BMI) hospitalization database of Xiantao City from January 2010 to December 2016. A total of 77,757 hospitalization records were included in our analysis. The out-of-pocket (OOP) expenses and reimbursement ratio (RR) were the two main outcome variables. Interrupted time series analysis with a segmented regression approach was adopted. Level and slope changes were reported to reflect short- and long-term effects, respectively. Results indicated that the number of high-cost inpatient visits, the average monthly hospitalization expenses, and OOP expenses per high-cost inpatient visit were increased after CII introduction. By contrast, the RR from BMI and non-reimbursable expenses ratio were decreased. The OOP expenses and RR covered by CII were higher than those uncovered. We estimated a significant level decrease in OOP expenses ( p < 0.01) and rise in RR ( p < 0.01), whereas the slope decreases of OOP expenses ( p = 0.19) and rise of RR ( p = 0.11) after the CII were non-significant. We concluded that the short-term effect of the CII policy is significant and contributes to decreasing OOP expenses and raising RR for high-cost groups, whereas the long-term effect is non-significant. These findings can be explained by increasing hospitalization expenses, many non-reimbursable expenses, low coverage for high-cost groups, and the unsustainability of the financing methods.

Keywords: interrupted time series study; critical illness insurance; high-cost; out-of-pocket; reimbursement ratio; financial burden (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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