The Role of Health Insurance and Patient Co-payment on Cost and Quality of Care of AMI patients

Presenter: Mingshan Lu, University of Calgary

Abstract

This study will examine the association between health insurance, measured by patient co-payment, and hospital quality of care indicators as well as mortality among acute myocardial infarction (AMI) patients in Harbin and Shanghai, China.

China is at a critical stage of healthcare system reform; evidence is urgently needed to assist policy makers to redesign its healthcare insurance system. Central to any health insurance reform is the empirical question of whether patient co-payment would affect cost and outcome of health services. The current health insurance and payment system in China provides us a unique opportunity to study this question.

We will use an analytical/prospective cohort study design. Hospital discharge abstract administrative data at three large affiliated teaching hospitals in Harbin and Shanghai will be used to identify AMI cases. In addition to medical chart review, we will abstract detailed cost information from hospital billing databases. We will study the association between patient co-payment and cost of AMI treatment during hospitalization, the level of hospital quality of care for AMI (i.e. prescribing medications and including utilization of invasive cardiac procedures), and health outcomes (i.e. mortality).

Although this observational study will generate information for raising more research questions, we hypothesize that 1. lower patient co-payment is associated with higher treatment cost; and 2. quality of care and health outcomes of AMI vary across insurance types but are better for patients with lower patient co-payment and more generous health insurance.