See the published version of this preprint at International Journal for Equity in Health.
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Hongxia Gao
Huazhong University of Science and Technology
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9439-3156
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This work is licensed under a CC BY 4.0 License. Read Full License
Background: Three types of Medical Alliances (MAs) have been built in most county regions in China. These MAs are led by main three county hospitals to drive the development of township hospitals. This paper aims to evaluate the actual effect of China’s MAs reform in rural area on inpatient distribution especially among different categories of MAs.
Methods：We obtained 2008-2015 claims data on enrolled residents from the New Cooperative Medical Scheme (NCMS) in Y County, Hubei Province of China. We considered January 2008–December 2010 as the pre-reform period and January 2011–December 2015 as the post-reform period. Independent sample t-test and single-group interrupted time series analysis (ITSA) were used to compare the number of inpatients per month in the three MAs including 3 county hospitals and 10 township hospitals before and after the reform. Paired t-test and multiple-group ITSA were used between township hospitals within MAs and outside MAs.
Results：The MAs reform in Y County increased the number of inpatients and improved the service capacity of both county hospitals and township hospitals within MAs. After the reform, the number of inpatients per month in county hospitals had an upward trend, with a slope of 31.01 person/month (P < 0.000). Approximately 19.99 new inpatients were admitted to township hospitals monthly after the reform (P<0.000). Furthermore, township hospitals within MAs had a substantial increase in the number of inpatients (10.45 new inpatients monthly) compared with those outside MAs.
Conclusion: The MAs reform in Y county effectively improved the capability of medical services in the county and decreased health inequality significantly. However, it also caused further imbalance in the county region in terms of the medical institutions among the three county hospitals and the different township hospitals, which contained the risk of new health inequality.
Keywords
Medical Alliances (MAs), inpatient distribution, effect comparison, interrupted time series analysis (ITSA), rural health
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View the published article at International Journal for Equity in Health.
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Reviewer #1 agreed
On 04 Jun, 2020
Editor assigned
On 03 Jun, 2020
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Invitations sent on 03 Jun, 2020
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On 02 Jun, 2020
Editor invited
On 02 Jun, 2020
Version 1
Posted 18 Dec, 2019
No comments provided
Editorial decision: Major Revision
On 06 May, 2020
Review #3 received
Received 24 Apr, 2020
Reviewer #3 agreed
On 10 Apr, 2020
Review #2 received
Received 07 Apr, 2020
Review #1 received
Received 31 Dec, 2019
Reviewer #2 agreed
On 16 Dec, 2019
Reviewers invited
Invitations sent on 12 Dec, 2019
Reviewer #1 agreed
On 12 Dec, 2019
Submission checks complete
On 11 Dec, 2019
Editor invited
On 11 Dec, 2019
Editor assigned
On 11 Dec, 2019
First submitted
On 10 Dec, 2019
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See the published version of this preprint at International Journal for Equity in Health.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Hongxia Gao
Huazhong University of Science and Technology
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9439-3156
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at International Journal for Equity in Health.
No community comments so far
Reviewer #1 agreed
On 04 Jun, 2020
Editor assigned
On 03 Jun, 2020
Reviewers invited
Invitations sent on 03 Jun, 2020
Submission checks complete
On 02 Jun, 2020
Editor invited
On 02 Jun, 2020
Version 1
Posted 18 Dec, 2019
No comments provided
Editorial decision: Major Revision
On 06 May, 2020
Review #3 received
Received 24 Apr, 2020
Reviewer #3 agreed
On 10 Apr, 2020
Review #2 received
Received 07 Apr, 2020
Review #1 received
Received 31 Dec, 2019
Reviewer #2 agreed
On 16 Dec, 2019
Reviewers invited
Invitations sent on 12 Dec, 2019
Reviewer #1 agreed
On 12 Dec, 2019
Submission checks complete
On 11 Dec, 2019
Editor invited
On 11 Dec, 2019
Editor assigned
On 11 Dec, 2019
First submitted
On 10 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at International Journal for Equity in Health.
Background: Three types of Medical Alliances (MAs) have been built in most county regions in China. These MAs are led by main three county hospitals to drive the development of township hospitals. This paper aims to evaluate the actual effect of China’s MAs reform in rural area on inpatient distribution especially among different categories of MAs.
Methods：We obtained 2008-2015 claims data on enrolled residents from the New Cooperative Medical Scheme (NCMS) in Y County, Hubei Province of China. We considered January 2008–December 2010 as the pre-reform period and January 2011–December 2015 as the post-reform period. Independent sample t-test and single-group interrupted time series analysis (ITSA) were used to compare the number of inpatients per month in the three MAs including 3 county hospitals and 10 township hospitals before and after the reform. Paired t-test and multiple-group ITSA were used between township hospitals within MAs and outside MAs.
Results：The MAs reform in Y County increased the number of inpatients and improved the service capacity of both county hospitals and township hospitals within MAs. After the reform, the number of inpatients per month in county hospitals had an upward trend, with a slope of 31.01 person/month (P < 0.000). Approximately 19.99 new inpatients were admitted to township hospitals monthly after the reform (P<0.000). Furthermore, township hospitals within MAs had a substantial increase in the number of inpatients (10.45 new inpatients monthly) compared with those outside MAs.
Conclusion: The MAs reform in Y county effectively improved the capability of medical services in the county and decreased health inequality significantly. However, it also caused further imbalance in the county region in terms of the medical institutions among the three county hospitals and the different township hospitals, which contained the risk of new health inequality.
Figure 1
This preprint is available for download as a PDF.
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