供方竞争的强化能否抑制中国医疗费用的上涨?--基于省级面板数据的实证分析

Can Intensified Supply-Side Competition Contain the Growth of China 's Health Expenditures?——Evidence from Provincial Panel Data

医疗供给侧供方竞争的强化对医疗费用的水平有何影响,在卫生经济学、产业组织经济学和医疗政策研究领域中一向是有争议的。基于传统的经济学原理,既有文献中存在着"竞争降费命题",但另有不少文献发现了反命题,即供方竞争的强化反而会推高医疗费用的宏观水平。论文基于2002—2016年中国省级面板数据进行计量分析,发现了两个貌似矛盾的现象:第一,医院密度的提高确有降费之效;第二,市场集中度提高(即大医院的兴起)也有降费之效。第一个现象确证了竞争降费命题,而第二个现象表面上看与竞争降费命题相悖,但实际上并非如此。大医院兴起的降费之效,是由一系列结构和制度性因素联合作用的结果。由此可以推测,在现阶段,中国新医改中两项貌似方向相反的举措,即提升供方竞争强度和推进医联体建设,都能产生一定的控费之效。

In the fields of health economics,industrial organization economics,and health care policy studies,there is a controversy over the impacts,if any,intensified supply-side competition has upon health care expenditures.Based on traditional doctrines of economics,a“competition reducing expenditure proposition”exists in the existing literature.Other scholars,however,havemade a counter-proposition:the intensification of supply-side competition would push up the macro level of health care expenditures.After analyzing provincial level panel data from 2002-2016,this studypresents two seemingly contradictory findings.First,the rise of hospital density compared to the population has produced an expenditure reduction effect.Second,the growth of market concentration(namely the rise of big hospitals)has also produced a similar effect.The first finding verifies the competition reducing expenditure proposition,but the second finding at first glance seems to cut against thefirst proposition.Actually,this is not so.The rise of big hospitals in China has reduced health care expendituresbut this is due to a number of structural and institutional factors.It can be inferred that these two seemingly directionally opposite measures in China s new health care reforms,namely intensifying the supply-side competition and promoting the integration of a variety of health care providers at different levels,are likely to reduce expenditures during the current period.