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. 2019 Sep 20;16(19):3528.
doi: 10.3390/ijerph16193528.

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

Lu Li  1 , Junnan Jiang  2 , Li Xiang  3 , Xuefeng Wang  4 , Li Zeng  5 , Zhengdong Zhong  6
Affiliations

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

Lu Li et al. Int J Environ Res Public Health. .

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: critical illness insurance; financial burden; high-cost; interrupted time series study; out-of-pocket; reimbursement ratio.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Graphical demonstration of interrupted time series (ITS) analysis. (a) CII policy effect on OOP expenses; (b) CII policy effect on Reimbursement Ratio (RR).
Figure 1
Figure 1
Location of sample city.
Figure 2
Figure 2
Trends of out-of-pocket (OOP) expenses in 2010–2016.
Figure 3
Figure 3
Trends of reimbursement ratio (RR) in 2010–2016.
See this image and copyright information in PMC

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