摘要
备受关注的“按病种分值付费”(DIP)改革在医疗费用控制上已初见成效,但鲜有文献讨论DIP改革对非政策目标群体的效应。本文利用中国G市在2018年1月1日仅针对当地患者实施DIP改革这一自然实验,使用15家三甲医院省内跨市异地就医患者的病案首页和医保结算数据,通过断点-双重差分法,估计了DIP改革对非目标群体(异地就医患者)的影响。结果显示,DIP改革使异地就医患者的单次住院费用增加约9.50%,患者个人负担费用增加约9.10%,这证实了医疗机构为应对DIP改革,会采取短期策略性转嫁行为。策略性转嫁的具体方式可能是增加异地就医患者的处置强度。
Reform of health insurance payment methods is essential to achieve the sustainable development of health insurance funds and thereby optimise the allocation of medical resources.The much-discussed“Diagnosis-Intervention Packet”(DIP) reform has achieved some initial results in controlling medical spending.However,the effect of DIP reform on non-target groups is understudied.Taking advantage of the natural experiment of implementing the DIP reform only in the case of local patients in G city on January 1,2018,this study estimates the impact of the DIP reform on the medical expenses of non-target groups(patients seeking medical treatment in alternative cities)using the regression-discontinuity-difference-in-differences(RD-DID) design.Empirical results of claims data from 15 tertiary hospitals show that the DIP reform has increased the total expenditure of hospitalizations for patients from other cities by RMB 2,261.533(an increase of approximately 9.50%),and patients’ outof-pocket expenses have increased by RMB 984.886(an increase of approximately 9.10%),which provides strong evidence for the short-term cost-shifting behavior of hospitals in response to DIP reform.Further analysis reveals that an increase in costs can be achieved by increasing the intensity of treatment.
作者
马超
杜妍蓉
唐润宇
徐伟
王天宇
Ma Chao;Du Yanrong;Tang Runyu;Xu Wei;Wang Tianyu
出处
《世界经济》
CSSCI
北大核心
2022年第11期177-200,共24页
The Journal of World Economy
基金
国家自然科学基金(72074045)
教育部人文社科基金(17YJC790155)的支持。
关键词
支付方式改革
按病种分值付费
异地就医
断点双重差分
payment method reform
Diagnosis-Intervention Packet(DIP)
remote medical treatment
regression discontinuity-difference-in-differences(RD-DID)
