Addressing government and market failures with payment incentives: Hospital reimbursement reform in Hainan, China
Addressing government and market failures with payment incentives: Hospital reimbursement reform in Hainan, China
复制标题
DOI：
10.1016/s0277-9536(03)00010-8
复制
发表时间：
2004-01-01
影响因子：
5.4
通讯作者：
Eggleston, K
中科院分区：
文献类型：
--
作者：
Yip, W;Eggleston, K
本文审查了提供者支付政策作为解决政府和市场失灵以及控制卫生部门成本的工具的作用，特别是在发展中国家。我们实证评估了海南省提供者支付改革对不同类别服务支出的影响，这些服务在服务收费下受到扭曲价格的影响。采用前后研究设计和对照组，我们分析了两年的索赔数据，以评估1997年1月对医院子样本的预期付款变化的影响。这种差异中的差异实证策略使我们能够将供给侧支付改革的影响与需求侧政策干预隔离开来。我们发现，与按服务收费相比，预付与昂贵药品和高科技服务支出的增长速度较慢有关。考虑到药品在中国卫生总支出的水平和增长中所占的比例都非常高，支付改革与最昂贵药品支出增长下降有关的事实尤其令人鼓舞。支付改革可以成为纠正市场失灵和政府卫生部门干预措施的不利副作用（如为确保获得基本服务而扭曲价格）的有效政策工具，这两者都可能导致保健支出过度增长。对发展中国家来说，这种卫生支出增长的机会成本可能特别高。(C) 2003 Elsevier Ltd.版权所有。
This paper examines the role of provider payment policy as an instrument for addressing government and market failures and controlling costs in the health sector, particularly in developing countries. We empirically evaluate the impact of provider payment reform in Hainan province, China, on expenditures for different categories of services that had been subject to distorted prices under fee-for-service. Using a pre-post study design with a control group, we analyze two years of claims data to assess the impact of a January 1997 change to prospective payment for a sub-sample of the hospitals. This difference-in-difference empirical strategy allows us to isolate the supply-side payment reform effects from demand-side policy interventions. We find that prepayment is associated with a slower increase in spending on expensive drugs and high technology services, compared to fee-for-service. The fact that payment reform is associated with reduced growth in spending on the most expensive drugs is particularly encouraging, given that drugs account for a remarkably high percentage of both the level and growth of aggregate health expenditure in China. Payment reform can be an effective policy instrument for correcting market failures and adverse side effects of government health sector interventions (such as distorted prices to assure access to basic services), both of which can lead to excessive health care expenditure growth. Such health spending growth can have a particularly high opportunity cost for developing countries. (C) 2003 Elsevier Ltd. All rights reserved.