Dataset Information

Factors associated with the inter-facility transfer of inpatients in Sichuan province, China.

ABSTRACT:

Background

The overuse of tertiary hospitals and underuse of primary care facilities has been one of the key reasons leading to fast health expenditure increase and health service utilization inequity in China. Recent health care reform in China tries to enforce a patient transfer system to make the health services utilization more efficient. This study examined the pattern and associated factors of inter-facility transfer of inpatients in Sichuan province of Western China.

Methods

Patient discharge records (n?=?1,490,695) from 604 general hospitals during the period of April to June 2015 in Sichuan were extracted from the front page of the medical records system with individual information on demographics, insurance coverage, diagnoses, hospitals admitted and discharge type. We calculated the percentage of inpatients transferring to other health facilities, the Inter-Facility Transfer Rate (IFTR) with adjustment for Charlson Comorbidity Index (CCI). Multi-level logistic regression models were established to identify factors associated with IFTRs.

Results

A small number of tertiary hospitals (n?=?75, 12.41%) shared 51.71% (n?=?770,823) of all admitted cases while a large number of primary/unrated hospitals (n?=?321, 53.15%) shared only 8.15%. The overall CCI-adjusted IFTR was 2.08% with 3.73% among secondary hospitals, 1.87% among tertiary hospitals and 1.30% among primary/unrated hospitals. Uninsured patients (OR?=?1.13) and those with a lower level of insurance entitlements (OR?=?1.12 for the New Rural Cooperative Medical Scheme and the Basic Medical Insurance for Urban Residents) were more likely to experience inter-facility transfer than those with a higher level of insurance entitlements (the Basic Medical Insurance for Urban Employees).

Conclusion

The level of IFTR in general hospitals in Sichuan is low, which is associated with the level of hospitals and insurance entitlements. Further studies are needed to better understand how patients and health care providers respond to different insurance policies and make decisions on inter-facility transfer.

SUBMITTER: Liu L

PROVIDER: S-EPMC6533730 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Publications

Factors associated with the inter-facility transfer of inpatients in Sichuan province, China.

Liu Linxin L Liu Chaojie C Duan Zhanqi Z Pan Jingping J Yang Min M

BMC health services research 20190523 1

<h4>Background</h4>The overuse of tertiary hospitals and underuse of primary care facilities has been one of the key reasons leading to fast health expenditure increase and health service utilization inequity in China. Recent health care reform in China tries to enforce a patient transfer system to make the health services utilization more efficient. This study examined the pattern and associated factors of inter-facility transfer of inpatients in Sichuan province of Western China.<h4>Methods</h ...[more]

PMID: 31122226

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Project description:BackgroundSince 1950, the hospitals had been permitted to take a 15% mark-up of drug purchase price to remedy the loss of public hospitals and doctors' salaries in China due to tight government budget. This policy resulted in an increasing over-prescriptions which increased burden for patients eventually. The soaring medical expenditures prompted Chinese government to launch the zero mark-up drug policy (ZMDP) in 2009, which aims to eliminate physicians' financial incentives and lighten patients' economic burden through cancelling the 15% mark-up. The purpose of this study is to assess the impacts of the ZMDP on hospitalization expenses for inpatients with chronic obstructive pulmonary disease (COPD) in western China.MethodAn interrupted time series was used to assess the impact of the ZMDP in 25 tertiary hospitals of Sichuan province, in which the policy was implemented in 2017. Monthly average total hospitalization expenses including drug expenses, medical service expenses and diagnosis expenses of COPD inpatients were analyzed with segmented regression model developed from January 2015 to June 2018.ResultsAfter the intervention of the ZMDP, the total hospitalization expenses of COPD patients significantly decreased immediately by 1022.06 CNY (P?=?.011). The post-policy long-term trend was decreasing by 125.32 CNY (P?<?.001) per month compared to the pre-policy period. The drug expenses kept downward trend both before and after the policy implementation. It had decreased by 46.42 CNY (P?<?.001) per month on average before the policy implementation and then dropped 1073.58 CNY (P?<?.001) immediately after the policy was implemented. Meanwhile, the medical service expenses had an increasing baseline trend of 14.93 CNY (P?<?.001) per month before the policy intervention, but it increased 197.75 CNY immediately after the policy was implemented (P?=?.011). The pre-policy period long-term trend of diagnosis expenses had increased by 25.78 CNY (P?<?.001) per month and decreased immediately by 310.78 CNY (P?=?.010). The post-policy trend was decreasing by 35.60 CNY (P?=?.001) per month compared to the pre-policy period.ConclusionOur study suggested that the ZMDP have been an effective intervention to curb the increase of hospitalization expenses for inpatients with COPD, especially the drug expenses in western region of China.

Dataset Information

Factors associated with the inter-facility transfer of inpatients in Sichuan province, China.

Background

Methods

Results

Conclusion

Publications

Factors associated with the inter-facility transfer of inpatients in Sichuan province, China.

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