International journal for quality in health care : journal of the International Society for Quality in Health Care · 2016
Effect of the medical insurance on the quality of care for Chinese patients with chronic heart failure.
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Fu Rong, Bao Han, Su Shaofei, Wang Xinyu, Zhang Meiqi, Liu Meina
Аннотация
OBJECTIVE: To assess the effect of medical insurance on the quality of care for patients with chronic heart failure (CHF).
DESIGN: Seven quality indicators were used to assess the association between medical insurance and quality of care. Statistical analyses were conducted using multilevel logistic models for the total population and the subpopulation stratified by sex and age.
PARTICIPANTS: In total, 1862 CHF patients who were admitted in 20 tertiary hospitals between 1 January 2009 and 31 October 2010.
RESULTS: Of 1862 patients, 53.8% patients had basic medical insurance and 26.9% patients paid the hospital costs by themselves. After adjusting for confounding factors, patients with New Rural Cooperative Medical Scheme (NRCMS) were more likely to receive warfarin (odds ratios [OR], 3.89; 95% confidence interval [CI], 1.08-13.99; P = 0.038), but less likely to receive aldosterone receptor antagonist (OR, 0.21; 95% CI, 0.08-0.56; P = 0.002) than patients without any medical insurance. Urban Employee Basic Medical Insurance (UEBMI) and NRCMS were associated with more use of discharge instructions ([OR, 3.54; 95% CI, 2.44-5.13; P < 0.001] and [OR, 2.09; 95% CI, 1.21-3.62; P = 0.009], respectively). After stratified by sex, male patients with UEBMI were more likely to receive the evaluation of left ventricular function than male patients without any medical insurance (OR, 1.78; 95% CI, 1.06-2.98; P = 0.029).
CONCLUSIONS: UEBMI and NRCMS could increase the adherence to quality indicators of CHF to some extent. Improving the medical insurance system is expected to achieve equality in medical security and improve the quality of care for CHF patients.
DESIGN: Seven quality indicators were used to assess the association between medical insurance and quality of care. Statistical analyses were conducted using multilevel logistic models for the total population and the subpopulation stratified by sex and age.
PARTICIPANTS: In total, 1862 CHF patients who were admitted in 20 tertiary hospitals between 1 January 2009 and 31 October 2010.
RESULTS: Of 1862 patients, 53.8% patients had basic medical insurance and 26.9% patients paid the hospital costs by themselves. After adjusting for confounding factors, patients with New Rural Cooperative Medical Scheme (NRCMS) were more likely to receive warfarin (odds ratios [OR], 3.89; 95% confidence interval [CI], 1.08-13.99; P = 0.038), but less likely to receive aldosterone receptor antagonist (OR, 0.21; 95% CI, 0.08-0.56; P = 0.002) than patients without any medical insurance. Urban Employee Basic Medical Insurance (UEBMI) and NRCMS were associated with more use of discharge instructions ([OR, 3.54; 95% CI, 2.44-5.13; P < 0.001] and [OR, 2.09; 95% CI, 1.21-3.62; P = 0.009], respectively). After stratified by sex, male patients with UEBMI were more likely to receive the evaluation of left ventricular function than male patients without any medical insurance (OR, 1.78; 95% CI, 1.06-2.98; P = 0.029).
CONCLUSIONS: UEBMI and NRCMS could increase the adherence to quality indicators of CHF to some extent. Improving the medical insurance system is expected to achieve equality in medical security and improve the quality of care for CHF patients.