# Impact of the health insurance deregulation policy for cross-regional healthcare on hospitalization visits and expenses of patients with ischemic heart disease: an interrupted time series analysis

## TL;DR

A health insurance deregulation policy increased hospital visits for heart disease patients without raising costs significantly.

## Contribution

This study is the first to evaluate the impact of health insurance deregulation on ischemic heart disease hospitalization patterns.

## Key findings

- The policy caused an immediate 20.27 increase in weekly hospitalizations for ischemic heart disease.
- Hospitalization costs continued to decline post-policy, similar to pre-policy trends.
- Insurance reimbursement costs shifted from decreasing to increasing after the policy implementation.

## Abstract

The health insurance deregulation policy aimed to enhance healthcare accessibility by eliminating intra-provincial administrative hurdles. However, its impact on hospitalization patterns of high-burden chronic conditions like ischemic heart disease (IHD) remains unexamined.

Interrupted time-series analysis (ITSA) was employed to evaluate weekly hospitalization visits and expenses for 8,522 IHD inpatients across three Hebei counties (January 2021–July 2023). Models assessed immediate and longitudinal changes post-policy, adjusting for autocorrelation and seasonal trends.

Policy implementation triggered an immediate 20.27 surge in weekly hospitalizations (p = 0.006), with sustained utilization unaffected (β3 = 0.17, p = 0.619). Per-visit hospitalization expenses maintained pre-deregulation policy declining trends (−126.71 CNY/week pre-policy vs. −32.04 CNY/week post-policy), despite a non-significant instantaneously increase by 478.43 (p = 0.723) in the first week following the implementation of this policy. Additionally, the health insurance deregulation policy reversed the weekly trend of insurance reimbursement costs per visit from decreasing (−81.98 CNY/week) to increasing trajectories (1.95 CNY/week, p = 0.004).

The health insurance deregulation policy successfully expanded IHD care access without exacerbating financial burdens, demonstrating that administrative simplification can coexist with cost containment under concurrent payment reforms.