Evidence map›Paper›PMID 42129748›Full record

ArticleBMC health services research2026

The effects of insurance coverage under Shanghai hospital global budget management.

Yanan Dai, Yuchen Xu, Xiaozhen He, Jian Zhang, Yerui Zhang, Yan Wang, Yunhao Xie, Huiyong Chen, Yuan Liu, Leilei Cheng

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Yanan Dai *Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, 200032, China.
Yuchen Xu *Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, NHC Key Laboratory of Ischemic Heart Diseases, Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China.
Xiaozhen He *Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, 200032, China.
Jian ZhangDepartment of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, NHC Key Laboratory of Ischemic Heart Diseases, Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China.
Yerui ZhangDepartment of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, 200032, China.
Yan WangDepartment of Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Yunhao XieZhongshan Hospital, Fudan University, Shanghai, 200032, China.
Huiyong ChenDepartment of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. chen.huiyong@zs-hospital.sh.cn.
Yuan LiuDepartment of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, NHC Key Laboratory of Ischemic Heart Diseases, Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China. liu.yuan@zs-hospital.sh.cn.
Leilei ChengDepartment of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, 200032, China. cheng.leilei@zs-hospital.sh.cn.

Funding

National Natural Science Foundation of China 82470354Shanghai Shenkang Hospital Development Center Project on Standardized Management and Promotion of Diagnostic and Therapeutic Techniques in Municipal Hospitals SHDC22023207Special Fund for Fundamental Research Expenses of Central Public Welfare Scientific Research Institutes, Chinese Academy of Medical Sciences 2024-JKCS-28the Major Project on Four Chronic Diseases 2023ZD0502800
6 · The paper itself

Abstract

backgroundAgainst the backdrop of rapidly rising healthcare expenditures and ongoing reforms in medical insurance payment systems, rigorous evaluation of payment policies and their impacts on medical behavior and outcomes is of critical importance.

methodsUsing 32,313 inpatient records from the cardiology and cardiothoracic surgery departments of a tertiary hospital in Shanghai between 2007 and 2015, this study constructs a quasi-experimental difference-in-differences (DiD) framework to assess the effects of the Shanghai global budget prepayment policy on hospital cost structures and healthcare quality.

resultsThe results indicate that the DiD estimator of the policy significantly reduced total inpatient expenditures, suggesting a more streamlined and rationalized cost structure. However, the implementation of the policy was also associated with a significant increase in in-hospital mortality, raising concerns about potential unintended consequences for patient outcomes. The 30-day readmission rate did not change significantly following the reform. To strengthen causal inference, propensity score matching was employed to balance patient characteristics across pre-and post-policy periods. The findings remain robust across multiple sensitivity analyses.

conclusionOverall, this study highlights the complex trade-offs between cost containment and care quality under payment reform and provides quantitative evidence to inform the optimization of global budget prepayment policies and the advancement of value-based healthcare.

Indexed as

BudgetsInsurance CoverageChinaFemaleHealth ExpendituresHospital MortalityHumansQuality of Health CareTertiary Care CentersDifference-in-differenceMedical expenseMedical insuranceMortalityReadmission

Identifiers

PMID42129748
PMCPMC13343601

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.