Does capitation prepayment based Integrated County Healthcare Consortium affect inpatient distribution and benefits in Anhui Province, China? An interrupted time series analysis

摘要

Objective: This study aims to compare the level and trend changes of inpatient and funds distribution, as well as inpatient benefits before and after the official operation of the ICHC in Anhui. Methods: A total of 1,013,815 inpatient cases were collected from the hospitalisation database in two counties in Anhui Province, China, during the course of the study from January 2014 to June 2017. The effect of the reform was assessed beginning with its formal operation in February 2016. Longitudinal time series data were analysed using segmented linear regression of an interrupted time series analysis. Results: The average hospitalisation expenses showed a decreasing trend and the actual compensation ratio increased significantly (p-value 0.01). Most of the indicators in the two counties performed well, and the effect of ICHC policy was better in Funan County than in Dingyuan County. The distribution of inpatients and NRCMS funds outside the county after the reform in Dingyuan showed an increasing trend (0.27, 95%CI: 0.12 to 0.42, p-value 0.01; 0.70, 95%CI: 0.32 to 1.09, p-value 0.01) and the distribution?of inpatients and NRCMS funds in THs showed a more obvious upward trend after the reform in Funan (0.44, 95%CI: 0.22 to 0.67, p-value 0.001; 0.34, 95%CI: 0.23 to 0.45, p-value 0.001). Conclusions: This study suggests that the ICHC policy provides effective strategies in promoting the integration of the healthcare delivery system in China. These strategies include strengthening family doctor signing service system and health management, developing telemedicine technology, reducing the weak points of the healthcare services, and introducing private hospitals to form new ICHCs.