The best of both worlds? The economic effects of a hybrid fee-for-service and prospective payment reimbursement system
The best of both worlds? The economic effects of a hybrid fee-for-service and prospective payment reimbursement system
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DOI：
10.1002/hec.4205
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发表时间：
2020-12-14
期刊：
影响因子：
2.1
通讯作者：
Noguchi, Haruko
中科院分区：
文献类型：
--
作者：
Fu, Rong;Shen, Yichen;Noguchi, Haruko
寻求摆脱纯收费服务制度的国家可考虑采取一种混合办法，即只有某些程序由收费服务支付费用，而其他程序则预先支付费用。然而，几乎没有证据表明，这种混合支付系统是否包含了总体成本，而不会对健康结果产生不利影响。2003年，日本经历了从FFS到混合支付系统的改革，其中只有一些住院手术是前瞻性支付的。我们利用这一改革来测试这种混合系统如何影响总体成本和健康结果。简而言之，我们发现医疗服务提供者对改革的反应是机会主义的，将一些程序从捆绑的住院设置转移到FFS服务，导致成本没有降低。有一些证据表明，在出院时治愈症状的可能性下降方面，健康结果出现了中度恶化。总之，我们的研究结果表明，在某些情况下，混合支付系统可以不优于FFS或预期的支付系统。
Countries seeking to move away from a purely fee-for-service (FFS) system may consider a hybrid approach whereby only some procedures are paid by FFS while others are paid prospectively. Yet little evidence exists whether such a hybrid payment system contains overall costs without adverse influences on health outcomes. In 2003, Japan experienced a reform from FFS to a hybrid payment system in which only some inpatient procedures were paid prospectively. We exploit this reform to test how such a hybrid system affects overall costs and health outcomes. Briefly, we find that healthcare providers responded opportunistically to the reform, moving some procedures out of the bundled inpatient setting to FFS services, leading to no reduction in cost. There was some evidence of a moderate deterioration in health outcomes, in terms of a decline in the probability of symptoms being cured at discharge. In sum, our results suggest that in some cases, a hybrid payment system can be non-superior to either FFS or prospective payment system.