Effects of expanding outpatient benefit package on the rationality of medical service utilisation of patients with hypertension: a quasi-experimental trial in rural China

BMJ Open. 2019 May 9;9(5):e025254. doi: 10.1136/bmjopen-2018-025254.


Objective: To estimate the effects of expanding outpatient benefit package on ameliorating the issues of over-reliance on inpatient services and seeking higher level medical services in rural China.

Design: A quasi-experimental design.

Setting and participants: 1673 pairs of patients with hypertension were selected after using propensity score matching from Dangyang county (intervention group) and Zhijiang (control group) county, Hubei province.

Intervention: The outpatient annual reimbursement capping line was expanding from ¥300 to ¥600, daily capping line from ¥10/12 to ¥150. The compensation scope and institution were also enlarged from January 2016.

Outcome measures: The difference-in-differences model was used to estimate the effects on medical service type selection. χ2 test was used to verify the effects on medical institution selection. We also examined the effects on health outcomes through the length of stay and blood pressure changes.

Results: The intervention was associated with 3.225 times (p=0.001) increase in total visits. Outpatient visits increased by 3.3 times (p=0.008), whereas the township level presented a maximum increase of 1.932 times (p=0.001). The inpatient visits declined by 0.075 times (p=0.000), whereas county-level inpatient visits reached a maximum decrease of 0.042 times (p=0.033). Meanwhile, the township level exhibited a maximum proportion growth of 14.8% in outpatient (p=0.000) and 13.3% in inpatient visits (p=0.048). Outpatient visits at the county level dropped at 13.2% (p=0.000), whereas inpatients visits declined by 7.7% (p=0.040). The length of stay and blood pressure were decreased, respectively, compared with the control group.

Conclusion: Improving outpatient benefit package alleviated patient dependence on inpatient services through motivating outpatient service utilisation, consolidated the primacy of township health centres and guided patients to return to primary medical institutions. The health insurance reform should 'take the long view' in the future, and more attention should be paid to the rationality of medical service utilisation.

Keywords: hypertension; medical service utilization; outpatient benefit package; rationality; rural areas.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Care / economics*
  • China / epidemiology
  • Delivery of Health Care / economics*
  • Female
  • Health Services Research
  • Humans
  • Hypertension / economics
  • Hypertension / epidemiology
  • Hypertension / therapy*
  • Insurance Benefits / economics*
  • Insurance Benefits / statistics & numerical data
  • Insurance, Health / statistics & numerical data
  • Male
  • Middle Aged
  • Outpatients / statistics & numerical data*
  • Propensity Score
  • Rural Health Services / economics*