Figure 1
The geolocation of Dingyuan County and Funan County in Anhui Province, China.
Table 1
Social economic status and other characteristic of sampling counties in 2016.
| Dingyuan | Funan | |
|---|---|---|
| Total area (km2) | 2998.0 | 1768.4 |
| GDP (billion RMB) | 166.3 | 145.6 |
| Resident population | 801000 | 1183000 |
| Rural population | 645732 | 603345 |
| Per capita disposable income of rural residents (RMB) | 10220 | 10196 |
| Number of CHs | 1 | 4 |
| Number of THs | 28 | 31 |
| Number of ICHCs | 1 | 3 |
| Number of outpatients of NRCMS | 101087 | 203255 |
| Hospital bed utilization ratio (%) | 35.64 | 42.36 |
| Average length of stay (LoS) of rural inpatients (days) | 5.77 | 7.59 |
| Number of health personnel per 1000 | 5.06 | 3.30 |
| Number of practicing physician per 1000 | 1.70 | 0.83 |
| Number of registered nurse per 1000 | 1.65 | 0.75 |
| Number of hospital bed per 1000 | 3.63 | 3.14 |
[i] Note: GDP, Gross Domestic Product; RMB, Ren Min Bi; CHs, County-level Hospitals; THs, Township-level Hospitals; ICHCs, Integrated County Healthcare Consortiums; NRCMS, New Rural Cooperative Medical System; LoS, Length of Stay.
Table 2
Descriptive statistics of inpatient characteristics in two counties.
| ICHC reform* | |||
|---|---|---|---|
| Items | Total | before | after |
| County | |||
| Dingyuan | 343,981(33.93) | 192,288(34.37) | 151,693(33.39) |
| Funan | 669,834(66.07) | 367,224(65.63) | 302,610(66.61) |
| Gender | |||
| Male | 560,008(55.24) | 310,660(55.52) | 249,347(54.89) |
| Female | 453,807(44.76) | 248,852(44.48) | 204,956(45.11) |
| Age, years | |||
| Less than 20 | 126,067(12.43) | 71,734(12.82) | 54,333(11.96) |
| 20–39 | 186,658(18.41) | 111,218(19.87) | 75,439(16.61) |
| 40–59 | 275,778(27.20) | 146,158(26.12) | 129,620(28.53) |
| 60–79 | 372,192(36.71) | 202,548(36.20) | 169,644(37.34) |
| More than 79 | 53,120(5.24) | 27,853(4.98) | 25,267(5.56) |
| Mean (SD) | 48.99 | 49.92 | 47.84 |
[i] Note: *We selected February 2016 (formal operation of the reform) as the time point for comparing characteristcs of inpatients before and after the intervention in two counties.
Table 3
Indicators of overall study population and subgroups of pre-intervention and post-intervention.
| Indicators | Regions | Overall study | Pre-intervention | Post-intervention |
|---|---|---|---|---|
| Constituent ratio of inpatients outside the county (%) | Dingyuan | 11.30 | 12.08 | 10.16 |
| Funan | 24.20 | 26.61 | 20.66 | |
| Constituent ratio of inpatients in CHs (%) | Dingyuan | 67.67 | 66.02 | 70.09 |
| Funan | 52.94 | 52.12 | 54.15 | |
| Constituent ratio of inpatients in THs (%) | Dingyuan | 20.94 | 21.74 | 19.76 |
| Funan | 22.86 | 21.27 | 25.19 | |
| Constituent ratio of NRCMS funds outside the county (%) | Dingyuan | 23.22 | 25.44 | 19.96 |
| Funan | 38.49 | 41.00 | 34.80 | |
| Constituent ratio of NRCMS funds in CHs (%) | Dingyuan | 69.32 | 66.57 | 73.36 |
| Funan | 52.03 | 49.83 | 55.27 | |
| Constituent ratio of NRCMS funds in THs (%) | Dingyuan | 7.39 | 7.87 | 6.68 |
| Funan | 9.48 | 9.17 | 9.93 | |
| Average hospitalisation expenses (RMB) | Dingyuan | 5825.21 | 5789.53 | 5877.68 |
| Funan | 5195.81 | 5275.38 | 5078.79 | |
| Actual compensation ratio (%) | Dingyuan | 49.31 | 46.43 | 53.55 |
| Funan | 54.03 | 52.03 | 56.97 |
Figure 2
The distribution of inpatients over time. Note: (A) Constituent ratio of inpatients outside the county in Dingyuan and Funan (%); (B) Constituent ratio of inpatients in CHs in Dingyuan and Funan (%); (C) Constituent ratio of inpatients in THs in Dingyuan and Funan (%).
Table 4
Estimated level and trend changes of indicators before and after the intervention in two counties.
| Coefficient (95%CI) | ||||
|---|---|---|---|---|
| Intercept | Preintervention trend | Level change | Trend change | |
| Constituent ratio of inpatients outside the county (%) | ||||
| Dingyuan | 15.24*** (13.17 to 17.31) | –0.26*** (–0.38 to –0.15) | 1.47 (–0.13 to 3.08) | 0.27** (0.12 to 0.42) |
| Funan | 27.63*** (26.26 to 28.99) | –0.08 (–0.19 to 0.02) | –0.48 (–3.09 to 2.14) | –0.46*** (–0.68 to –0.25) |
| Constituent ratio of inpatients in CHs (%) | ||||
| Dingyuan | 57.21*** (52.37 to 62.05) | 0.73*** (0.42 to 1.05) | –5.17* (–9.82 to 0.52) | –0.77* (–1.21 to –0.34) |
| Funan | 49.94*** (47.97 to 51.90) | 0.18** (0.06 to 0.30) | –1.93 (–5.17 to 1.31) | 0.02 (–0.26 to 0.30) |
| Constituent ratio of inpatients in THs (%) | ||||
| Dingyuan | 27.01*** (23.79 to 30.23) | –0.44*** (–0.66 to –0.22) | 3.47* (0.13 to 6.81) | 0.47** (0.16 to 0.79) |
| Funan | 22.43*** (20.85 to 24.02) | –0.10 (–0.21 to 0.02) | 2.41 (–0.46 to 5.28) | 0.44*** (0.22 to 0.67) |
| Constituent ratio of NRCMS funds outside the county (%) | ||||
| Dingyuan | 31.85*** (26.40 to 37.31) | –0.53** (–0.86 to –0.21) | 0.10 (–4.20 to4.40) | 0.70** (0.32 to 1.09) |
| Funan | 44.13*** (41.29 to 46.96) | –0.32** (–0.53 to –0.11) | 3.56 (–1.58 to 8.72) | –0.30* (–0.71 to 0.11) |
| Constituent ratio of NRCMS funds in CHs (%) | ||||
| Dingyuan | 58.40*** (51.43 to 65.37) | 0.68** (0.25 to 1.11) | –0.51 (–6.17 to 5.15) | –0.87* (–1.41 to 0.34) |
| Funan | 45.71*** (42.71 to 48.72) | 0.40** (0.18 to 0.61) | –3.20 (–8.16 to 1.75) | –0.04* (–0.46 to 0.37) |
| Constituent ratio of NRCMS funds in THs (%) | ||||
| Dingyuan | 9.37*** (7.66 to 11.08) | –0.13* (–0.24 to –0.01) | 0.25 (–1.57 to 2.06) | 0.17* (–0.03 to 0.33) |
| Funan | 10.16*** (9.52 to 10.80) | –0.08*** (–0.12 to –0.04) | –0.37 (–1.32 to 0.59) | 0.34*** (0.23 to 0.45) |
| Average hospitalisation expenses (RMB) | ||||
| Dingyuan | 5005.05*** (4605.84 to 5404.27) | 65.37*** (38.69 to 92.06) | –304.55 (–873.59 to 264.50) | –122.52*** (–186.52 to –58.51) |
| Funan | 5003.84*** (4758.65 to 5249.02) | 22.63* (2.81 to 42.45) | –124.69 (–541.19 to 291.81) | –68.39** (–108.35 to –28.43) |
| Actual compensation ratio (%) | ||||
| Dingyuan | 52.02*** (49.13 to 54.92) | –0.47** (–0.73 to –0.20) | 7.69** (3.33 to 12.05) | 1.15*** (0.76 to 1.54) |
| Funan | 51.88*** (50.40 to 53.35) | 0.01 (–0.11 to 0.14) | –1.71** (–4.81 to 1.39) | 0.80*** (0.57 to 1.03) |
[i] Note: ***, **, * means statistically significant at the 0.1%, 1% and 5% levels respectively; CI: Confidence interval.
Figure 3
The distribution of NRCMS funds over time. Note: (A) Constituent ratio of NRCMS funds outside the county in Dingyuan and Funan (%); (B) Constituent ratio of NRCMS funds in CHs in Dingyuan and Funan (%); (C) Constituent ratio of NRCMS funds in THs in Dingyuan and Funan (%).
Figure 4
The benefits of inpatients over time. Note: (A) Average hospitalisation expenses in Dingyuan and Funan (CNY); (B) Actual compensation ratio in Dingyuan and Funan (%).