Constructing a value-based healthcare system for hypertensive patients through changing payment mode: evidence from a comparative study in rural China

To construct a value-based healthcare system for rural Chinese hypertensive patients through an increasing outpatient care reimbursement ratio.This comparative study sampled two similar counties, Dangyang County and Zhijiang County, in Hubei Province of China, as the intervention group and the control group, respectively. The Social Health Insurance Fund of the intervention group budgeted 600 yuan per capita per year to insured patients with third stage hypertension to cover their outpatient expenditures, while the outpatient expenditures of the control group were not covered by its Social Health Insurance Fund. The inpatient expenditure reimbursement policies in both groups were not adjusted during the study. Value improvement in this study was defined as reduction in medical costs and improvement in health outcomes within the pilot healthcare system. A propensity score matching model combined with a difference-in-differences model was used to estimate the changes in medical costs and health outcomes.In total, 1,673 pairs of patients were enrolled into statistical analysis after the propensity score matching. The intervention increased per capita annual outpatient expenditure by 81.2 (+31.8%) yuan (p .05), but decreased the per capita annual inpatient expenditure and total medical expenditure by 475.4 (-40.7%) yuan and 394.2 (-27.7%) yuan, respectively (p .05). Accordingly, the per capita annual total medical expenditure reimbursement decreased by 192.3 (-28.5%) yuan (p .05), and the per capita annual total out-of-pocket expenditure by 201.9 (-29.9%) yuan (p .05). The diastolic blood pressure of the intervention group decreased significantly by 2.9 mmHg (p .05), but no significant change was found in systolic blood pressure and prevalence of hypertension complications (p .05).Increasing the outpatient expenditures, the reimbursement ratio was beneficial to the value of the healthcare system for hypertensive patients. Outpatient care for patients with chronic diseases should be prioritized for rural China and healthcare settings with inadequate health insurance funds.