公立医院规模扩张与过度医疗——来自医院等级变化的证据

Scale Expansion and Overtreatment of Public Hospitals: Evidence from the Change of Hospital Rank

本文以医院等级变化为背景,实证考察公立医院在规模扩张过程中的过度医疗行为。首先利用医院层面的长时间追踪数据,发现过度医疗主要发生在评级之前,具体表现为:在评级前医院会明显增加设备投入和医疗人员引进,以满足相关评级指标要求,而此时由于受到医疗服务价格以及药占比的管制,医院主要通过提高住院率、检查费用等措施来进行收入补偿;在评级之后,医疗服务价格相应上调,但患者次均医疗费用及费用结构却没有随价格上调而表现出明显的变化。进一步利用医院与医保患者住院费用结算信息匹配之后的数据,本文得到了同样的结论:医院在药占比的约束下,主要通过增加患者次均住院检查费用向患者转移成本,表现出在评级前药占比显著下降,检查占比显著上升的趋势,但这一趋势在评级后趋于稳定。

Based on the change of hospital rank,this paper empirically investigates the overtreatment behavior of public hospitals in the process of scale expansion.Firstly,using the long-term tracking data at the hospital level,this paper finds that the excessive medical treatment mainly occurs before the rating.The specific performance is that before the rating,the hospital will significantly increase the investment of equipment and medical staff to meet the requirements of the relevant rating indicators.When the price of medical services is regulated,hospitals cannot raise the price of medical services,but make income compensation by increasing the rate of hospitalization and the expense of inspection.After the rating,the price of medical services is increased correspondingly,while the average medical expenses and the expense structure of inpatients do not change significantly with the rise of the price.Further using the data matched by the hospital characteristics and inpatient expenses of insured,we get the same conclusion:under the constraint of the declining drug proportion year by year,the hospital does not reduce the average drug expense of inpatients,but significantly increases the average inspection expense of inpatients.Thus,before rating,the proportion of drug decrease significantly,while the proportion of inspection increase significantly,but this trend tends to be stable after rating.