Does Hospital Accreditation Increase Inpatient Expenditure and Improve Quality of Care? Evidence from Heart Failure Admissions in County-Level Public Hospitals in China
- 1School of Public Management, Chongqing Technology and Business University, Chongqing, 400067, People’s Republic of China
- 2Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
Abstract
Background: Hospital accreditation aims to strengthen hospital capacity and improve quality of care, but its effects on inpatient expenditure, patient cost sharing and quality remain unclear. We estimate these effects in county-level public hospitals in China.
Methods: We use administrative claims data from Zunyi, China. Four county-level public hospitals that passed tertiary hospital accreditation in 2021 comprise the treatment group. The control group comprises 17 hospitals that remained at the secondary level. We analyse 6844 heart failure admissions among adults aged 18 years or older from December 2020 to November 2022. The eligible cohort comprised 6,844 admissions; after matching, the analytical cohort comprised 3,920 admissions, and 3,874 were eligible for the readmission analysis. We combine propensity score matching with a difference-in-differences model to estimate the effects on total health expenditures per inpatient case, out-of-pocket costs per inpatient case, the patient cost-sharing rate and the 30-day all-cause readmission rate.
Results: Hospital accreditation increased total health expenditures per inpatient case by 3.99% (P = 0.046). It did not significantly change out-of-pocket costs (−8.00%, P = 0.304), the patient cost-sharing rate (−2.12 percentage points, P = 0.143) or the 30-day all-cause readmission rate (+3.96 percentage points, P = 0.117). In subgroup analyses, total health expenditures increased significantly among both URRBMI and UEBMI inpatients and among inpatients admitted to Traditional Chinese Medicine hospitals. No subgroup showed a significant reduction in the 30-day all-cause readmission rate.
Conclusion: Our estimates indicate that tertiary hospital accreditation increased total health expenditures per inpatient case but did not significantly alter patient cost sharing or the 30-day all-cause readmission rate. Post-accreditation evaluation should jointly assess expenditures across the episode of care, financial protection and quality of care.
Related
- COVID-19 and psychiatric inpatient admissions at a Saudi tertiary hospital, 2017-2024: an interrupted time-series study
- Trends and Changing Clinical Profiles in Adolescent Mental Health Inpatient Admissions: A Time-Series and Comparative Study Over the Period 2011–2024
- Mixed-Methods Analysis of a National Survey of Hospitals With Inpatient Hepatitis C Treatment Initiatives
- Associations of short-term exposure to multiple air pollutants with hospital admissions for ischemic stroke in Lanzhou, China
- Comorbidity patterns and inpatient expenditure among patients with coronary heart disease in China.
BibTeX
@article{tan2026does,
title = {{Does Hospital Accreditation Increase Inpatient Expenditure and Improve Quality of Care? Evidence from Heart Failure Admissions in County-Level Public Hospitals in China}},
author = {Huawei Tan and Hao Fang},
journal = {Risk Management and Healthcare Policy},
year = {2026},
month = oct,
doi = {10.2147/rmhp.s651860},
url = {https://doi.org/10.2147/rmhp.s651860},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Does Hospital Accreditation Increase Inpatient Expenditure and Improve Quality of Care? Evidence from Heart Failure Admissions in County-Level Public Hospitals in China
AU - Huawei Tan
AU - Hao Fang
PY - 2026
DA - 2026/10/30
JO - Risk Management and Healthcare Policy
DO - 10.2147/rmhp.s651860
UR - https://doi.org/10.2147/rmhp.s651860
AB - Background: Hospital accreditation aims to strengthen hospital capacity and improve quality of care, but its effects on inpatient expenditure, patient cost sharing and quality remain unclear. We estimate these effects in county-level public hospitals in China. Methods: We use administrative claims data from Zunyi, China. Four county-level public hospitals that passed tertiary hospital accreditation in 2021 comprise the treatment group. The control group comprises 17 hospitals that remained at the secondary level. We analyse 6844 heart failure admissions among adults aged 18 years or older from December 2020 to November 2022. The eligible cohort comprised 6,844 admissions; after matching, the analytical cohort comprised 3,920 admissions, and 3,874 were eligible for the readmission analysis. We combine propensity score matching with a difference-in-differences model to estimate the effects on total health expenditures per inpatient case, out-of-pocket costs per inpatient case, the patient cost-sharing rate and the 30-day all-cause readmission rate. Results: Hospital accreditation increased total health expenditures per inpatient case by 3.99% (P = 0.046). It did not significantly change out-of-pocket costs (−8.00%, P = 0.304), the patient cost-sharing rate (−2.12 percentage points, P = 0.143) or the 30-day all-cause readmission rate (+3.96 percentage points, P = 0.117). In subgroup analyses, total health expenditures increased significantly among both URRBMI and UEBMI inpatients and among inpatients admitted to Traditional Chinese Medicine hospitals. No subgroup showed a significant reduction in the 30-day all-cause readmission rate. Conclusion: Our estimates indicate that tertiary hospital accreditation increased total health expenditures per inpatient case but did not significantly alter patient cost sharing or the 30-day all-cause readmission rate. Post-accreditation evaluation should jointly assess expenditures across the episode of care, financial protection and quality of care.
SN - 1179-1594
ER -