单病种付费对住院分娩服务提供方行为的影响

Impact of single disease payment system on hospital delivery service providers' behavior

目的:研究由按项目付费到单病种付费的支付改革中,住院分娩服务提供方行为是否受到影响。方法:选择2007年1月1日由按项目付费转变为单病种付费的陕西省周至县为研究组,一直实行按项目付费的山西省广灵县为对照组。对2005年11月1日至2010年12月31日1 050例住院分娩病例进行回顾性分析,运用双重差分估计法分析住院分娩费用和住院天数这两种反映服务提供方行为的指标变化情况。结果:控制产次、住院天数、分娩方式以及补偿方式等变量后,住院分娩费用的双重差分参数估计量为-262.73(P<0.001),即表示单病种付费使住院分娩费用降低了262.73元;而控制产次和分娩方式后,住院天数的双重差分估计量为0.53(P>0.05),即表示住院天数没有受到影响。结论:按项目付费转变为单病种付费制度影响了住院分娩服务提供方控制费用的行为,促使服务提供方将住院分娩费用控制在单病种限价付费标准之下,同时约束服务提供方诱导需求的行为,但并未促使服务提供方缩短住院分娩的平均住院天数。对于政策制定者而言,与按项目付费相比,在新型农村合作医疗制度和农村孕产妇住院分娩补助政策的推行下,单病种付费制度是控制住院分娩费用的有效手段。

Objective：To find out whether single disease payment system would have an impact on hos- pital delivery service providers＇ behavior. Methods： Zhouzhi County in Shaanxi Province where there was a payment change from fee for service （FFS） to single disease payment in 2007 was selected as the treatment group, and Guangling County in Shanxi Province with FFS was selected as the control group. Using a difference-in-difference （DD） design, this study empirically examined the impact of single disease payment on the cost of hospital delivery and length of stay. The data of 1 050 samples were taken from the hospitalization medical records and list of charges in the hospitals between 2005-11-01 and 2010-12-31. Results： When taking the expense as dependent variable, the estimated value of DD variable was -262.73 with parity, length of stay, delivery mode, and payment controlled, which was significant at the 1%~ level. It indicated that the expense had decreased by 262.73 yuan after single disease payment was introduced. When taking the length of stay as dependent variable, the estimated value of DD variable was 0.53, which was not significant at the 5% level, meaning that the length of stay was not different between single disease payment and FFS. Conclusion： The payment change from FFS to single disease payment has an impact on hospital delivery service providers＇ behavior. It could make hospitals try their best to reduce the expenses under the price ceiling to avoid paying for the exceeding cost, and it also can restrict induced demand, but it could not motivate hospitals to reduce length of stay. This research provides evidence for policy makers that compared with FFS, single disease payment system is an effective payment method for controlling the expense of hospital delivery under the new cooperative medical scheme （NCMS） and the policy of subsidy for rural hospital delivery （SRHD） .