Abstract
Since May 2011, CSMBS patients have been allowed to get certain elective surgeries in accredited
private hospitals. The scheme pays private hospitals by case-based payment, Diagnosis Related Group
(DRG), and the hospitals can charge extra for bed and board and doctor fee. This study aims to assess
utilization trend of CSMBS patients for certain elective surgeries in both public and private hospitals prior
to and after policy implementation, and its impacts on service utilization of UCS members, efficiency of
service provision, and burden of expenditure on patients and the scheme. Claim administrative databases
of the CSMBS and UCS were employed in the analysis.
Results reveal that Intraocular Lens (IOL) Replacement for cataract was major procedure used in
private hospitals, 80%, followed by childbirth (5%) and knee replacement (3%). the number of patients
receiving IOL has been prominently increased following the policy. This was due to relatively high payment
rate for IOL, active screening for patients with cataract in communities together with no co-payment
policy and free transportation provided by one private hospital chain who was major provider under this
policy (74% of cases). Shifting of CSMBS patients to private hospitals let public hospitals having more
available beds and doctor’s time for UCS patients. The numbers of childbirth and knee replacement in
private hospitals under the policy were low due to lack of active marketing, relatively high copayment
especially for knee replacement. Negative impact on public hospitals located in provinces where many
patients got care from private hospitals was not found. Under prospective payment system, private hospitals
were more efficient in managing resources. Private hospitals selected better paid procedures in the
provision; moreover, there was huge variation in the level of copayments for same procedure of different
private hospitals. The policy increased expenditure on private inpatient care; however, it did not affect
overall expenditure of the scheme.
In conclusion, the policy increased access to IOL replacement for cataract patients among CSMBS
members; however, monitoring and evaluation system should be strengthened before scaling up the program.
