Yong Yang - Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China
Xiaowei Man - School of Management, Beijing University of Chinese Medicine, Beijing, China
Zhe Yu - Guang&#۰۳۹;anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
Stephen Nicholas - Australian National Institute of Management and Commerce, Sydney, NSW, Australia
Elizabeth Maitland - University of Liverpool Management School, University of Liverpool, Liverpool, UK
Zhengwei Huang - School of Management, Beijing University of Chinese Medicine, Beijing, China
Yong Ma - China Health Insurance Research Association, Beijing, China
Xuefeng Shi - School of Management, Beijing University of Chinese Medicine, Beijing, China

Background  Stroke is one of the leading public health issues in China and imposes a heavy financial burden on patients and the healthcare system. This study assess which payment method provides the lowest hospital costs for China’s healthcare system and the lowest out-of-pocket (OOP) expense for insured patients.Methods  This is a ۴-year cross-sectional study. From the China Health Insurance Research Association (CHIRA) database, a ۵% random sample of urban health insurance claims was obtained. Descriptive analysis was conducted and a generalized linear model (GLM) with a gamma distribution and a log link was estimated.Results  For outpatients, capitation payment had the lowest hospital cost (RMB۱۸۰.۹/US۲۸.۸) and lowest OOP expenses (RMB۷۵.۶/US۱۲.۰) per patient visit in primary hospitals compared with fee-for-service (FFS) payments. The global budget (GB) displayed the lowest total hospital costs (RMB۳۴۴.۷/US۵۴.۸) in secondary hospitals, and was ۲۷.۴% (۹۵% CI = -۰.۳۲, -۰.۲۹) lower than FFS. FFS had the lowest OOP expenses (RMB۱۲۳.۴/US۱۹.۶ vs. RMB۱۵۱.۸/US۲۴.۱) in secondary and tertiary hospitals. For inpatients, FFS had the lowest total hospital costs (RMB۵۹۱۸.۷/US۹۴۱.۱) per visit and capitation payments had the lowest OOP expenses (RMB۸۷۶.۵/US۱۳۹.۴, ۴۰.۱% lower than FFS, ۹۵% CI = -۰.۵۸, -۰.۱۵) in primary hospitals. Capitation payment had both the lowest hospital costs (RMB۷۳۴۲.۹/US۱۱۶۷.۵ vs. RMB۱۷ ۷۱۱.۷/US۲۸۱۶.۲) and the lowest OOP expenses (RMB۱۶۶۴.۲/US۲۶۴.۶ vs. RMB۳۲۷۶.۳/US۵۲۰.۹) for both secondary and tertiary hospitals.Conclusion  For outpatients in primary hospitals and inpatients in secondary and tertiary hospitals, the capitation payment was the most money-saving payment method delivering both the lowest OOP expenses for patients and the lowest hospital total costs for hospitals. We recommend that health policymakers prioritize the implementation of the payment method with the lowest OOP expenses when the payment method does not deliver both the lowest hospital costs for the health system and lowest OOP expenses for patients.

Payment Method, Health Insurance, Health Expenditure, Out-of-Pocket Payment, Stroke