Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 17, Issue 1, 2014. Pages: 25-32
Published Online: 1 March 2014

Health Insurance in China: Variation in Co-Payments and Psychiatric Hospital Utilization

Yanling Zhou¹, Robert A. Rosenheck², Hongbo He¹*

¹ Neuropsychiatric Research Institute, Guangzhou Psychiatric Hospital, the affiliated hospital of Guangzhou Medical University, Guangzhou, China
² Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

* Correspondence to: Hongbo He, Neuropsychiatric research institute, Guangzhou Psychiatric Hospital, Guangzhou, China.
Tel.: +86-20-81 563 414
Fax: +86-20-81 891 391
E-mail address: hongbo_he@yeah.net

Source of Funding: This study was supported from funding to H.H. from Chinese National Key Clinical Program in Psychiatry to Guangzhou Brain Hospital, Guangzhou, China (No. 201201001) and funding from Guangzhou Municipal Health Bureau (No. 20131A011083). The funding source had no role in the study design, analysis or interpretation of data or in the preparation of the report or decision to publish.

Abstract

In China, it is unclear whether the depth of insurance coverage affects the accessibility, length of stay (LOS) of inpatient mental health services or not. This study aims to examine the relationship between variation in insurance coverage to the accessibility of inpatient mental health care and to the intensity and care as measured by length of stay (LOS).Using administrative data from the Guangzhou Psychiatric Hospital (GPH), we found that between April 1, 2010 and March 31, 2013, 8,478 patients were discharged with an average LOS of 75.1 (sd =244.3) days, and Logistic regression analysis showed that insurance plans with lower co-payments were significant predictors of multiple psychiatric admissions and longer LOS.It suggested that patients with the most extensive coverage were most likely have previous admissions, suggesting easier access to psychiatric hospitalization, and longer LOS, reflecting the impact of reduced risk for impoverishing out-of-pocket expenditures.

Background: Economic reform in China 30 years ago virtually eliminated all public health insurance. In the last 10 years, diverse government insurance programs have been implemented, now covering 95% of the population, primarily for inpatient care. While the development of health care in China is an incomplete work in progress and highly variable, it is unclear whether the depth of insurance coverage affects the accessibility, length of stay (LOS) of inpatient mental health services or not.

Aim of the Study: This study aims to examine the relationship between variation in insurance coverage, accessibility to inpatient mental health care and intensity of care as measured by length of stay (LOS).

Methods: Using administrative data from the Guangzhou Psychiatric Hospital (GPH), we used regression models to determine the relationship between the depth of insurance coverage and the likelihood of hospital utilization and LOS net of sociodemographic characteristics and diagnosis.

Results: Between April 1, 2010 and March 31, 2013, 8,478 patients were discharged with ICD-10 psychiatric diagnoses with an average LOS of 75.1 (sd =244.3) days, among which 4,727 (55.8%) patients were first admissions. Logistic regression analysis showed that insurance plans with lower co-payments were significant predictors of multiple psychiatric admissions and longer LOS.

Implications for Health Policy: These data point to significant variability in the health insurance coverage in China and indicate a clear need for greater equalization in future years. Although the Chinese government has provided at least shallow coverage to virtually all of its citizens at this stage, further efforts are needed to expand and equalize coverage as economic development proceeds, especially in rural areas.

Implications for Further Research: Although variation in health insurance plans in China are extensive and impact the accessibility and duration of psychiatric hospital care, their impact on outcomes and use of post-discharge outpatient care is unknown and requires further study.

Received 29 August 2013; accepted 1 December 2013