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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (4): 753-758. doi: 10.19723/j.issn.1671-167X.2025.04.020

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Impact of outpatient services utilization of heart failure patients on hospitalization rate and its threshold effect: Taking patients with Urban Employee Basic Medical Insurance in Zhejiang Province as an example

Huyang ZHANG1, Rize JING2, Jinxi WANG3, Hai FANG4,5,*()   

  1. 1. National School of Development, Peking University, Beijing 100871, China
    2. School of Public Administration and Policy, Renmin University of China, Beijing 100872, China
    3. Shanghai Songsheng Business Consulting Co. Ltd, Shanghai 201913, China
    4. China Center for Health Development Studies, Peking University, Beijing 100191, China
    5. Peking University Health Science Center-Chinese Center for Disease Control and Prevention Joint Center for Vaccine Econo-mics, Beijing 100191, China
  • Received:2022-10-10 Online:2025-08-18 Published:2025-08-02
  • Contact: Hai FANG
  • Supported by:
    the National Natural Science Foundation of China(71774006)

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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 patients 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 hospitalization rates. Specifically, policymakers should consider the identified thresholds when designing reimbursement policies for heart failure patients, which may help to optimize the use of medical resources and reduce the burden of medical expenses.

Key words: Urban Employee Basic Medical Insurance, Heart failure, Outpatient services utilization, Hospitalization rate, Threshold effect

CLC Number: 

  • R197.1

Table 1

Basic information of patients with heart failure in year 2017 (n=7 243)"

Items Data
Gender (Female), n(%) 3 087 (42.6)
Age, n(%)
    ＜50 years 828 (11.4)
    50-59 years 1 289 (17.8)
    60-69 years 1 559 (21.5)
    70-79 years 1 600 (22.1)
    ≥80 years 1 967 (27.2)
Annual hospitalization, n(%) 2 237 (30.9)
Rehospitalization within 30 days, n(%) 618 (27.6)
Rehospitalization within 90 days, n(%) 947 (42.3)
Annual outpatient visits, median (IQR) 24 (27)
Annual outpatient expenses/yuan, median (IQR) 6 240.7 (8 761.5)
Annual outpatient drug expenses/yuan, median (IQR) 2 389.0 (7 131.7)
Annual outpatient self-expenses within policy/yuan, median (IQR) 1 334.2 (2 239.0)
Having annual outpatient drug expenses, n(%) 4 994 (68.9)

Table 2

Impact of last year' s outpatient service utilization on whether to be hospitalized this year in Zhejiang Province (Logistic regression)"

Items Annual hospitalization rate Rehospitalization rate within 30 days Rehospitalization rate within 90 days
Model 1 Model 2 Model 1 Model 2 Model 1 Model 2
Annual outpatient visits
    Coefficient -0.14*** -0.16*** -0.025 -0.10 -0.047 -0.14
    95%CI -0.22, -0.07 -0.25, -0.07 -0.18, 0.13 -0.31, 0.10 -0.19, 0.10 -0.32, 0.05
    n 13 563 8 280 2 770 1 449 3 361 1 866
Annual outpatient expenses
    Coefficient -0.13*** -0.15*** -0.009 0 -0.034 0.002 8 -0.024
    95%CI -0.18, -0.08 -0.21, -0.09 -0.10, 0.09 -0.17, 0.10 -0.09, 0.10 -0.15, 0.10
    n 13 856 8 501 2 833 1 496 3 430 1 916
Annual outpatient drug expenses
    Coefficient -0.12*** -0.14*** -0.020 -0.013 -0.040 -0.063
    95%CI -0.18, -0.07 -0.21, -0.07 -0.13, 0.09 -0.16, 0.13 -0.15, 0.07 -0.20, 0.07
    n 10 281 6 272 2 328 1 198 2 757 1 527
Annual outpatient self-expenses within policy
    Coefficient -0.096*** -0.14*** -0.088 -0.086 -0.057 -0.11
    95%CI -0.15, -0.04 -0.20, -0.07 -0.20, 0.02 -0.23, 0.06 -0.16, 0.04 -0.25, 0.03
    n 11 971 7 263 2 526 1 331 3 031 1 693
Whether have annual outpatient drug expenses
    Coefficient -1.24*** -1.17*** -0.11 -0.22 -0.61** -0.75***
    95%CI -1.43, -1.04 -1.38, -0.96 -0.50, 0.28 -0.68, 0.23 -1.00, -0.23 -1.20, -0.31
    n 20 909 14 769 3 888 2 378 4 880 3 166

Table 3

Threshold effect of utilization of annual outpatient services on annual hospitalization rate (threshold regression)"

Variables of annual outpatient services Model 1 Model 2
Threshold Coefficients P value Threshold Coefficients P value
Annual outpatient visits ≤12.0 -0.165 0.069 ≤14.3 -0.286 0.002
>12.0 -0.138 0.787 >14.3 -0.116 0.111
Annual outpatient expenses/yuan ≤3 342.8 -0.083 0.059 ≤2 677.4 -0.108 0.064
>3 342.8 -0.149 0.207 >2 677.4 -0.171 0.351
Annual outpatient drug expenses/yuan ≤1 374.8 0.048 0.524 ≤1 169.7 0.018 0.847
>1 374.8 -0.155 0.012 >1 169.7 -0.169 0.059
Annual outpatient self-expenses within policy/yuan ≤736.9 -0.086 0.089 ≤983.7 -0.209 ＜0.001
>736.9 -0.100 0.807 >983.7 -0.086 0.071
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