Impact of outpatient services utilization of heart failure patients on hospitalization rate and its threshold effect:Taking patients with Urban Employee Basic Medical In-surance in Zhejiang Province as an example
10.19723/j.issn.1671-167X.2025.04.020
- VernacularTitle:心力衰竭患者门诊服务利用对住院率的影响及其阈值效应——以浙江省城镇职工患者为例
- Author:
Huyang ZHANG
1
;
Rize JING
;
Jinxi WANG
;
Hai FANG
Author Information
1. 北京大学国家发展研究院,北京 100871
- Publication Type:Journal Article
- Keywords:
Urban Employee Basic Medical Insurance;
Heart failure;
Outpatient services utilization;
Hospitalization rate;
Threshold effect
- From:
Journal of Peking University(Health Sciences)
2025;57(4):753-758
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To examine the impact of outpatient service utilization on hospitalization rates in patients with heart failure,with a focus on identifying the threshold effect,and to provide evidence to support the design of outpatient medical insurance reimbursement policies for heart failure patients.Methods:Using a stratified random sampling method,individual reimbursement data of heart failure pa-tients covered by Urban Employee Basic Medical Insurance in Zhejiang Province from year 2013 to 2017 were extracted.A panel fixed-effects logit regression model and a threshold effect model were applied to analyze the impact of annual outpatient service utilization in the previous year on the hospitalization rate in the current year and to identify the threshold effect.The annual outpatient service utilization indicators included the annual outpatient visits,annual outpatient expenses,annual outpatient drug expenses,and annual outpatient self-expenses within the policy.Hospitalization rate indicators comprised the annual hospitalization rate,rehospitalization rate within 30 days,and rehospitalization rate within 90 days.Results:(1)The study found that an increase in prior-year annual outpatient service utilization led to a decrease in the current-year annual hospitalization rate.However,the effects on the rehospitalization rate within 30 days and rehospitalization rate within 90 days were not statistically significant;(2)The thre-shold effect of prior-year annual outpatient service utilization on the current-year annual hospitalization rate was also identified.When the prior-year annual outpatient visits were less than or equal to the threshold(12 visits),the current-year annual hospitalization rate decreased as the prior-year annual outpatient visits increased and statistically significant,and the regression coefficient was not significant when the prior-year annual outpatient visits were higher than the threshold(12 visits).Correspondingly,the thresholds for annual outpatient expenses and annual outpatient self-expenses within policy in the previous year were 3 342.8 yuan and 736.9 yuan,respectively.Conclusion:There is a threshold effect of prior-year annual outpatient service utilization on the current year's annual hospitalization rate in heart failure patients.These results have important implications for designing outpatient health insurance policies for heart failure patients to improve the patients' utilization of outpatient services and decrease the hospitali-zation rates.Specifically,policymakers should consider the identified thresholds when designing reim-bursement policies for heart failure patients,which may help to optimize the use of medical resources and reduce the burden of medical expenses.
