OBJECTIVES

: We aim to evaluate the difference of two typical payment methods for the new rural cooperative medical scheme (NRCMS) on the utilisation of inpatient services in China.

METHODS

: Dingyuan and Weiyuan Counties were selected as the sample counties according to the two forms of global budget in eastern and western China. Data were derived from two databases in two counties, namely, National Dataset for NRCMS and electronic health records (EHRs). The sample consists of 343,981 and 187,603 hospitalisation records from the National Dataset and 3036 admission records from EHRs. We used interrupted time-series analysis (ITSA) and propensity score matching (PSM) to the measure the difference between the two typical payment methods to the utilisation of inpatient services in China.

RESULTS

: After the reform was formally implemented, distribution of inpatients in county hospitals (DIC), distribution of inpatients in township hospitals (DIT) and the actual compensation ratio of inpatients (ARCI) were not statistically significant. Compared with the two other methods, kernel matching obtained better results in reducing the mean and median of the absolute standardised bias of covariates of appropriateness of admission (AA) (mean bias = 2.8; median bias = 2.0), appropriateness of disease (AD) (mean bias = 2.2; median bias = 1.4). The difference in AA and AD of the matched inpatients between two groups was −0.03 (p-value = 0.042, 95% CI: −0.08 to 0.02) and 0.21 (p-value < 0.001, 95% CI: −0.17 to 0.25), respectively.

CONCLUSIONS

: Certain differences in the utilisation of inpatient services may arise owing to the differences in the system designs of different payment methods for NRCMS in China. Analysis of the causes of these differences can be used to guide inpatients to better use medical services, through the transformation and integration of payment systems. Therefore, the reasons for the differences have a positive reference for different countries and regions.