医院竞争对医疗费用的影响:中国的证据与机制

Hospital Competition and Medical Expenses:Evidence and Mechanisms in China

本文利用某城市城职保患者2013-2015年单病种住院数据考察医院竞争对二、三级医院医疗费用的影响及其影响机制.研究发现竞争使三级医院显著降低医疗费用,而对二级医院的总费用没有显著影响.通过进一步考察竞争影响医疗费用的四个机制,我们发现,竞争降低了患者的个人医疗支出;二级医院还会通过延长住院天数和增加诊疗服务来吸引患者;竞争会使医院用非手术治疗替代手术治疗;三级医院面对竞争降低了各项医疗费用,而二级医院则会对费用做结构性调整,增加诊疗费用而减少其他各项费用.本文的研究表明,即使是在公立医院为主的医疗体系中,医院之间的竞争也会带来费用下降、服务数量增加和治疗方式的改变.

This paper investigates the influence of hospital competition on medical expenses in the Chinese urban health care system.We investigated the competitive effect of secondary and tertiary hospitals respectively by using data on urban employee medical insurance participants in a city from 2013 to 2015.We found that intense competition significantly decreases the medical expenses in tertiary hospitals;specifically,competition reduces personal out-of-pocket medical spending.By contrast,for secondary hospitals,competition has no significant impact on the total cost.Secondary hospitals also attract patients by providing more services.In addition,secondary and tertiary hospitals replace surgical treatment with non-surgical treatment in the face of competition.Finally,the tertiary hospitals reduce various medical expenses,while the secondary hospitals increase treatment costs and reduce other costs.