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  • Impact of reimbursement rates on the length of stay in tertiary public hospitals: a retrospective cohort study in Shenzhen, China

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Health services research
Original research
Impact of reimbursement rates on the length of stay in tertiary public hospitals: a retrospective cohort study in Shenzhen, China
  1. Jie Ning1,
  2. Lingrui Liu2,
  3. Emily Cherlin2,
  4. Yarui Peng1,
  5. Jingkai Yue1,
  6. Haoling Xiong1,
  7. Hongbing Tao1
  1. 1Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  2. 2Department of Health Policy and Management, Yale School of Public Health, Global Health Leadership Initiative, Yale University, New Haven, Connecticut, USA
  1. Correspondence to Mr Jingkai Yue; yuejingkai1995123{at}live.com

Abstract

Objective To examine the association between reimbursement rates and the length of stay (LOS).

Design A retrospective cohort study.

Setting The study was conducted in Shenzhen, China by using health administrative database from 1 January 2015 to 31 December 2017.

Participants 6583 patients with acute myocardial infarction (AMI), 12 395 patients with pneumonia and 10 485 patients who received percutaneous coronary intervention (PCI) surgery.

Measures The reimbursement rate was defined as one minus the ratio of out-of-pocket to the total expenditure, multiplied by 100%. The outcome of interest was the LOS. Multilevel negative binomial regression models were constructed to control for patient-level and hospital-level characteristics, and the marginal effect was reported when non-linear terms were available.

Results Each additional unit of the reimbursement rate was associated with an average of an additional increase of 0.019 (95% CI, 0.015 to 0.023), 0.011 (95% CI, 0.009 to 0.014) and 0.013 (95% CI, 0.010 to 0.016) in the LOS for inpatients with AMI, pneumonia and PCI surgery, respectively. Adding the interaction term between the reimbursement rate and in-hospital survival, the average marginal effects for the deceased inpatients with AMI and PCI surgery were 0.044 (95% CI, 0.031 to 0.058) and 0.034 (95% CI, 0.017 to 0.051), respectively. However, there was no evidence that higher reimbursement rates prolonged the LOS of the patients who died of pneumonia (95% CI, −0.013 to 0.016).

Conclusions The findings indicate that the higher the reimbursement rate, the longer the LOS; and implementing dynamic supervision and improving the service capabilities of primary healthcare providers may be an important strategy for reducing moral hazard in low-income and middle-income countries including China.

  • length of stay
  • reimbursement rates
  • moral hazard
  • low-income and middle-income countries
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-040066

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    Footnotes

    • Contributors JN, JY and HT conceived the study idea and interpreted the data. JN, LL and EC drafted and revised the article. YP and HX undertook the statistical analysis. JY was the principal investigator of the project. All authors have approved the final version of the manuscript for publication. The authors disclosed the receipt of the following financial support for the research, authorship and/or publication of this article.

    • Funding This work was supported by the National Natural Science Foundation of China (Grant Number: 71774061).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Confidential information including name, ID card number, residential address, postal code and insurance number were excluded from the database. Huazhong University of Science and Technology, which was not directly engaged with the data collection, exempted the study as human subject research for secondary analysis of data as defined by DHHS regulations 45 CFR 46.102.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request from the Public Hospital Management Center in Shenzhen.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.