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Table 3 Provider payment methods and their impacts on cost control of health care in selected cities of China

From: Controlling cost escalation of healthcare: making universal health coverage sustainable in China

  Shanghai Shenzhen Mudanjiang
Provider payment
  • Global budget as main method;
• Case-based payment for specific services [10].
• Fixed unit rate for inpatient services;
• Case-based payment for specific services [10].
• Case-based payment as main method;
• Fixed unit rate and FFS for specific services [10].
  OP services/ CHCs Global budget FFS for outpatient services Fixed unit rate for OP visits.
  IP admission Global budget, while case-based payment used for selected diseases A fixed unit rate payment for hospital admissions Case-based payment for IP admission, with capped annual ceiling.
  Special cases/services Flat daily rate payment for inpatients with mental health problems Case-based payment for normal baby deliveries FFS for specific services as defined.
Other cost control measures Rational use of drugs and high tech Drug expenditure as % of total health revenue of designated hospitals by health insurance scheme should reduce year by year;
Regulate the services and prices of high technology related services [11].
A monitoring and evaluation of prescribed drugs introduced in all the public hospitals.
Expenditure of antibiotics should not be more than 20% of the total drug expenditures.
Each prescription provides patients with drugs for only up to 3 days [14].
  Service delivery management Strengthening management of service referring system. Defining the ratio of outpatient visits to IP admission to control induced hospital admissions [13]. Level of case-based payment or unit rate differs between different levels of hospitals [15].
Impacts Cost escalation of health care The annual increase rate of health care expenditure for main health insurance schemes has been around 11.7% a level similar to the annual GDP growth rate in Shanghai [12]. Average health expenditure per the insured has been maintained at a stable level (e.g., RBM 646.2 yuan in 2003, RBM 587.3 yuan in 2004) The increases in OP and IP expenses were slower than the increase of average GDP per capita. The 2007 statistical data show that the average expenditure per hospital admission in the city was 28% lower than the national average [16].
  Health insurance funds A balanced situation maintained in terms of incomes and expenditures. The health insurance fund maintains a modest surplus annually The health insurance fund has a modest surplus.