Effect of an outpatient copayment scheme on health outcomes of hypertensive adults in a community-managed population in Xinjiang, China

• Published in: PloS one 2020-09, Vol.15 (9), p.e0238980-e0238980
• Main Authors: Yin, Hongpo, Ma, Xiaochen, He, Yanli, Liang, Rujiang, Wang, Yongxin, Zhang, Mei, Mao, Lu, Jing, Mingxia
• Format: Article
• Language: English
• Subjects: Adults; Ambulatory care; Analysis; Antihypertensives; Blood pressure; Care and treatment; Chronic illnesses; Confidence intervals; Cost control; Family size; Finance; Health care costs; Health care policy; Health insurance; Hypertension; Medicaid; Medicine; Medicine and Health Sciences; Patient outcomes; Patients; Population; Public health; Questionnaires; Risk analysis; Risk factors; Rural areas; Sample size; Social Sciences; Statistical analysis; Surveys; Uninsured people
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0238980

Hypertension remains the leading risk factor for death and disability in China, and the ability of hypertensive patients to pay for outpatient care and medication has become a critical issue. To report the effect of an outpatient copayment scheme on health outcomes of hypertensive adults in a community-managed population in Xinjiang, we compared changes in outcomes between insured and uninsured groups from baseline to the first follow-up appointment in a community-managed hypertensive population and evaluated these changes based on propensity score matching and the difference-in-difference method. A total of 1,095 individuals in a community-managed hypertension population were selected for investigation at baseline, among which 805 (73.5%) had follow-up data and 749 (68.4%) were included in our analysis. After accounting for the self-reported severity of hypertension and individual characteristics, there were statistically significant improvements in drug treatment of hypertension and self-reported health. We also found increases in drug treatment for hypertension between groups, after correcting for confounding variables (Odds Ratio, OR 8.05, 95% Confidence interval, CI, 1.31-49.35), and in self-reported health between groups after correcting confounders (OR 1.96, 95% CI, 1.12 to 3.42). Adjusted estimates (confounding variables) were corrected for age, sex, income, marital status, education level, employment, family size, self-reported severity of hypertension, course of hypertension, and number of medications. As a result, decreased outpatient copayment was associated with an increase in antihypertensive treatment coverage, and an improvement in self-reported health among community-managed hypertensive populations in Xinjiang, China.