医保支付方式改革与医疗服务供给——来自四川省A市医保总额控制的证据

Medical Insurance Payment Reform and Medical Service Supply——Evidences from the Global Budget in City A,Sichuan Province

医保支付方式改革是全面深化医药体制改革的重要问题,对于控制医疗费用上涨和改善医疗服务质量有重要意义。本文使用医疗机构数据和住院患者数据,采用双重差分法研究了四川省A市2016年推行医保总额控制对医疗服务供给的影响。研究发现,医保总额控制的控费效果在不同类型医疗机构间存在异质性,基层卫生服务机构和一级及未定级医院的多个细分项费用上升,二级医院总费用显著降低,三级医院的控费努力表现为将手术治疗替换为非手术治疗。此外,基层卫生服务机构的规模扩大,实有床位数和住院人次数明显上升;二级医院的医疗服务效率提高,住院天数降低且住院人次数增加。最后,三级医院的医疗服务质量改善,但基层卫生服务机构和一级及未定级医院的医疗服务质量有降低的风险。研究结果表明,医保总额控制的控费效果有限,并需要警惕新的激励扭曲。

The reform of medical insurance payment method is a crucial issue in comprehensively deepening the reform of health care system, which is of great significance in controlling the rise of medical costs and improving the quality of medical care.Based on medical institution data and inpatient discharge data, this paper used the difference-in-differences method to investigate the impact of the Global Budget on health care supply in 2016 in City A,Sichuan Province.The results showed that the cost-control effect of the Global Budget varied among different types of medical institutions.Some subdivision fees increased in primary and unclassified hospitals, total inpatient cost decreased in secondary hospitals, and tertiary hospitals replaced surgical procedures with less expensive non-surgical procedures as their efforts in cost control.In addition, the Global Budget increased the size of primary health centers, with a significant increase in the number of actual hospital beds and inpatient admissions.It also improved the efficiency of secondary hospitals, with a decrease in the length of stay and an increase in the number of inpatient admissions.Finally, the Global Budget improved the quality of care in tertiary hospitals, while primary health centers and primary and unclassified hospitals were at risk of getting worse.The findings suggest that the cost-control effect of the Global Budget is limited, and vigilance against new incentive distortions is required.