Implications of International Experience for Building China's Long-term Care Insurance System / 中国卫生经济

Objective:To introduce several international long-term care insurance systems so as to provide references for building China's long-term care insurance system.Methods:Literature of International long-term care insurance system were reviewed to extract and summarize the content so as to provide suggestion and references for China's system construction.Results:It concluded 4 modes of systems for long-term care insurance including the private long-term care social insurance like Netherlands,the public long-term care social insurance like German and Japan,long-term care commercial insurance like America and national long-term care insurance like England.The advantages of different modes could be learned to form Chinese system.Conclusion:The long-term care insurance systems of Netherlands,German,Japan,American could be learned for our system construction,but they also had disadvantages.Therefore,on the basis of the foster strengths and circumvent weaknesses,the reasonable long-term care insurance system was formed.

Analysis of substitutional effect of outpatient expenditure on inpatient expenditure in hypertensive patients with rural new cooperative medical scheme / 北京大学学报(医学版)

Objective:To study direct medical cost of hypertensive patients without complicated disea-ses,to analyze substitution impacts of outpatient expenditure on inpatient expenditure,and then to make recommendations to health policy makers and hypertensive patients for managing hypertension.Methods:The claims data of hypertensive patients insured by the rural new cooperative medical scheme in a city in northern China from 2008 to 201 3 were analyzed,descriptive statistics employed to analyze direct medical cost of hypertensive patients and hypertensive patients without complicated diseases which was one of the three groups divided by medical treatment conditions (hypertension without complicated diseases,hyper-tension with complicated diseases,and other diseases),and the differences between groups compared by t test.The fixed effect two-part model was employed to analyze the substitution effect of outpatient services on inpatient services,and specific effects of outpatient times and reimbursement expenses on the inpatient expenditure were calculated by Logistic regression analysis.Results:For the hypertensive pa-tients,the average cost of outpatients was 283.49 Yuan in 2008 and rose to 370.93 Yuan in 201 3.After being divided into three groups,for hypertensive patients without complicated diseases,the average cost of outpatient was 449.79 Yuan in 2008 and rose to 582.53 Yuan in 201 3.In the total cost of the outpa-tient,45.73% was for the hypertensive patients without complicated diseases;in the total cost of the in-patient,only 9.29% was for the hypertensive patients without complicated diseases.By calculating the marginal effect of parameter estimation through the fixed effect two-part model,the inpatient cost could be significantly reduced by increasing the visit times of outpatient utilization or the cost of outpatient reim-bursement.For example,in 201 3,a 1 % rise of outpatient visit times increased outpatient expenditures by 6.48 million Yuan,which could reduce inpatient expenditures by 39.86 million Yuan.The substitu-ted ratio of outpatient cost on inpatient cost had been around 5 in 201 0 and later.Conclusion:The health policy-makers and hypertensive patients should pay more attentions to the substitution of outpatient cost for inpatient cost,especially for the hypertensive patients without complicated diseases whose direct medical cost was mainly due to outpatient rather than inpatient costs.