Health financing systems & drug use in rural China
Author: Dong, Hengjin
Date: 2000-01-31
Location: Rehabsalen, plan 1, Norrbackabyggnaden, Karolinska Sjukhuset
Time: 9.30
Department: Institutionen för folkhälsovetenskap / Department of Public Health Sciences
Abstract
This thesis airns to study the association between health-care financing
systems and health-care consumers' drug use and health providers'
prescribing in six Chinese counties.
In a cross-sectional study, a multistage sampling procedure was used to
select provinces, counties, townships and villages. A simple random
sampling rnethod was used to select health facilities. A quota sampling
rnethod was used to select outpatients and a systematic sampling method
to select providers. Face-to-face outpatient interviews and health
provider survey were carried out in 1995. Outpatients were interviewed by
trained interviewers using questionnaires. Health provider were asked to
fill out self-administered questionnaires.
The findings of this study suggest that there is an association between
health-financing systems and patients' drug use, care-seeking behaviour,
and health providers' prescribing.
The uninsured patients had a significantly higher average number of drugs
per visit. and were prescribed antibiotics to a significantly higher
degree than the insured, a small proportion of them using newer
antibiotics. The insured patients, however, had significantly higher
average medical (drug) costs than the uninsured. Most health providers
were of the opinion that the patients' insurance was related to their
prescribing of treatment, that a bonus in relation to the revenue from
drug prescriptions provided an incentive for providers to over-prescribe,
and that the insured patients had a better access to expensive drugs and
were to a greater extent referred to specialised health facilities.
Health providers' choice and use of drugs were influenced by the market
factors. In 1994, more insured patients than uninsured were hospitalised
at the suggestion of a doctor. A logistic regression analysis showed that
only 'out-of-pocket' payment influenced the proportion of hospitalised
patients and that the influence was negative. The fee-for-service- based
insurance led to a higher growth of health care cost, to a shift from
preventive to curative medicine and to a higher level of tertiary
Curative care cost. It also induced a higher per capita consumption of
drugs.
It was found that the uninsured patients received more drugs at lower
drug Costs per visit than the insured. This implies that they received
cheaper drugs than the insured. The insured patients, however, had a
better access to expensive drugs and treatment. This implies that the
uninsured patients do not have the same access to health care for similar
needs. The findings from the health provider Survey and from tile patient
interviews and prescription analyses in the same health facilities are
consistent.
In conclusion, the health-care financing systems appear to influence
patients' drug use and health providers' prescribing. Insured patients
have significantly higher average medical (drug) costs per visit, and
better access to expensive drugs and treatment such as hospitalization
than uninsured. Health providers' prescribing are influenced by patients'
insurance status and financial abilities, bonus payment mechanism, and
market factors. The fee- for-service-based insurance leads to a higher
growth of health care cost, to a shift from preventive to curative
medicine and to a higher level of tertiary curative care cost. It also
induces a higher per capita consumption of drugs.
Efficiency and equity in access to health caee are the two important
aspects of China's new health policy. In order to realize the new policy
China should finance health services by different benefitpackages within
social insurance financed by general tax, employers and individuals in
tile urban and also in the rural areas.
List of papers:
I. Bogg L, Dong H, Wang K, Cai W, Diwan V (1996). "The cost of coverage: rural health insurance in China" Health Policy Plan 11(3): 238-252
Pubmed
II. Dong H, Bogg L, Wang K, Rehnberg C, Diwan V (1999). "A description of outpatient drug use in rural China: evidence of differences due to insurance coverage" Int J Health Plann Manage 14(1): 41-56
Pubmed
III. Dong H, Bogg L, Rehnberg C, Diwan V (1999). "Association between health insurance and antibiotics prescribing in four counties in rural China" Health Policy 48(1): 29-45
Pubmed
IV. Dong HJ, Bogg L, Rehnberg C, Diwan V (1999). "Health financing policies: providers opinions and prescribing behaviour in rural China" Int J Technol Assess Health Care 15: 686-698
V. Dong H, Bogg L, Rehnberg C, Diwan V (1999). "Drug policy in China: pharmaceutical distribution in rural areas" Soc Sci Med 48(6): 777-786
Pubmed
VI. Dong HJ (1970). "Health financing policies: patient care-seeking behaviour in rural China" (Submitted)
I. Bogg L, Dong H, Wang K, Cai W, Diwan V (1996). "The cost of coverage: rural health insurance in China" Health Policy Plan 11(3): 238-252
Pubmed
II. Dong H, Bogg L, Wang K, Rehnberg C, Diwan V (1999). "A description of outpatient drug use in rural China: evidence of differences due to insurance coverage" Int J Health Plann Manage 14(1): 41-56
Pubmed
III. Dong H, Bogg L, Rehnberg C, Diwan V (1999). "Association between health insurance and antibiotics prescribing in four counties in rural China" Health Policy 48(1): 29-45
Pubmed
IV. Dong HJ, Bogg L, Rehnberg C, Diwan V (1999). "Health financing policies: providers opinions and prescribing behaviour in rural China" Int J Technol Assess Health Care 15: 686-698
V. Dong H, Bogg L, Rehnberg C, Diwan V (1999). "Drug policy in China: pharmaceutical distribution in rural areas" Soc Sci Med 48(6): 777-786
Pubmed
VI. Dong HJ (1970). "Health financing policies: patient care-seeking behaviour in rural China" (Submitted)
Issue date: 2000-01-10
Publication year: 2000
ISBN: 91-628-3982-9
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