Browsing by Author "Ying, Xiaohua"

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    Anatomy of provincial level inequality in maternal mortality in China during 2004-2016: a new decomposition analysis.
    (BMC public health, 2020-05) Zhang, Xinyu; Ye, Yingfeng; Fu, Chaowei; Dou, Guanshen; Ying, Xiaohua; Qian, Mengcen; Tang, Shenglan

    Background

    The maternal mortality ratio (MMR) is an important indicator of maternal health and socioeconomic development. Although China has experienced a large decline in MMR, substantial disparities across regions are still apparent. This study aims to explore causes of socioeconomic related inequality in MMR at the province-level in China from 2004 to 2016.

    Methods

    We collected data from various issues of the China Health Statistics Yearbook, China Statistics Yearbook, and China Population and Employment Statistics Yearbook to construct a longitudinal sample of all provinces in China. We first examined determinants of the MMR using province fixed-effect models, accounted for socioeconomic condition, health resource allocation, and access to health care. We then used the concentration index (CI) to measure MMR inequality and employed the direct decomposition method to estimate the marginal impact of the determinants on the inequality index. Importance of the determinants were compared based on logworth values.

    Results

    During our study period, economically more deprived provinces experienced higher MMR than better-off ones. There was no evidence of improved socioeconomic related inequality in MMR. Illiteracy proportion was positively associated with the MMR (p < 0.01). In contrast, prenatal check-up rate (p = 0.05), hospital delivery rate (p < 0.01) and rate of delivery attended by professionals (p = 0.02) were negatively associated with the MMR. We also find that higher maternal health profile creation rate (p < 0.01) was associated with a pro-poor change of MMR inequality.

    Conclusion

    Access to healthcare was the most important factor in explaining the persistent MMR inequality in China, followed by socioeconomic condition. We do not find evidence that health resource allocation was a contributing factor.
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    Hospital response to a new case-based payment system in China: the patient selection effect.
    (Health policy and planning, 2024-05) Zhang, Xinyu; Tang, Shenglan; Wang, Ruixin; Qian, Mengcen; Ying, Xiaohua; Maciejewski, Matthew L
    Providers have intended and unintended responses to payment reforms, such as China's new case-based payment system, i.e. Diagnosis-Intervention Packet (DIP) under global budget, that classified patients based on the combination of principal diagnosis and procedures. Our study explores the impact of DIP payment reform on hospital selection of patients undergoing total hip/knee arthroplasty (THA/TKA) or with arteriosclerotic heart disease (AHD) from July 2017 to June 2021 in a large city. We used a difference-in-differences approach to compare the changes in patient age, severity reflected by the Charlson Comorbidity Index (CCI), and a measure of treatment intensity [relative weight (RW)] in hospitals that were and were not subject to DIP incentives before and after the DIP payment reform in July 2019. Compared with non-DIP pilot hospitals, trends in patient age after the DIP reform were similar for DIP and non-DIP hospitals for both conditions, while differences in patient severity grew because severity in DIP hospitals increased more for THA/TKA (P = 0.036) or dropped in non-DIP hospitals for AHD (P = 0.011) following DIP reform. Treatment intensity (measured via RWs) for AHD patients in DIP hospitals increased 5.5% (P = 0.015) more than in non-DIP hospitals after payment reform, but treatment intensity trends were similar for THA/TKA patients in DIP and non-DIP hospitals. When the DIP payment reform in China was introduced just prior to the pandemic, hospitals subject to this reform responded by admitting sicker patients and providing more treatment intensity to their AHD patients. Policymakers need to balance between cost containment and the unintended consequences of prospective payment systems, and the DIP payment could also be a new alternative payment system for other countries.
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    Impact of Diagnosis-Intervention Packet Payment in S City on the Healthcare Quality of Diseases Concerned by the National Public Hospital Performance Assessment
    (Chinese Journal of Health Policy, 2023-04-25) Zhang, Xinyu; Yan, Jiaqi; Wang, Ruixin; Lyu, Dawei; Qian, Mengcen; Ying, Xiaohua
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    Pathway to Adjustment of Relative Weight in DRG Payment System Reform in Shanghai
    (Chinese Health Resources, 2022-01-20) Zhang, Xinyu; Lyu, Dawei; Qian, Mengcen; Yan, Jiaqi; Xu, Hong; Shen, Yi; Ying, Xiaohua
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    Study on Impact of Diagnosis-Intervention Packet Reform on the Quality of Healthcare
    (Chinese Hospital Management, 2023-12-05) Zhang, Xinyu; Yan, Jiaqi; Wang, Ruixin; Lyu, Dawei; Qian, Mengcen; Ying, Xiaohua
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    The pilot of a new patient classification-based payment system in China: The impact on costs, length of stay and quality
    (Social Science & Medicine, 2021-11) Qian, Mengcen; Zhang, Xinyu; Chen, Yajing; Xu, Su; Ying, Xiaohua
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    Variations in the impact of the new case-based payment reform on medical costs, length of stay, and quality across different hospitals in China: an interrupted time series analysis
    (BMC Health Services Research) Tang, Xue; Zhang, Xinyu; Chen, Yajing; Yan, Jiaqi; Qian, Mengcen; Ying, Xiaohua
    AbstractBackgroundIn 2018, an innovative case-based payment scheme called Diagnosis-Intervention Packet (DIP) was piloted in a large developed city in southern China. This study aimed to investigate the impact of the new payment method on total medical expenditure per case, length of stay (LOS), and in-hospital mortality rate across different hospitals.MethodsWe used the de-identified patient-level discharge data of hospitalized patients from 2016 to 2019 in our study city. The interrupted time series model was used to examine the impact of the DIP payment reform on inflation-adjusted total expenditure per case, LOS, and in-hospital mortality rate across different hospitals, which were stratified into different hospital ownerships (public and private) and hospital levels (tertiary, secondary, and primary).ResultsWe included 2.08 million and 2.98 million discharge cases of insured patients before and after the DIP payment reform, respectively. The DIP payment reform resulted in a significant increase of the monthly trend of adjusted total expenditure per case in public (1.1%,P = 0.000), tertiary (0.6%,P = 0.000), secondary (0.4%,P = 0.047) and primary hospitals (0.9%,P = 0.039). The monthly trend of LOS increased significantly in public (0.022 days,P = 0.041) and primary (0.235 days,P = 0.032) hospitals. The monthly trend of in-hospital mortality rate decreased significantly in private (0.083 percentage points,P = 0.002) and secondary (0.037 percentage points,P = 0.002) hospitals.ConclusionsWe conclude that implementing the DIP payment reform yields inconsistent consequences across different hospitals. DIP reform encouraged public hospitals and high-level hospitals to treat patients with higher illness severities and requiring high treatment intensity, resulting in a significant increase in total expenditure per case. The inconsistencies between public and private hospitals may be attributed to their different baseline levels prior to the reform and their different responses to the incentives created by the reform.