医院竞争的患者福利效应分析——来自公立医院改革准自然实验的证据

Analysis of Patient Welfare Effects of Hospital Competition:Evidence From a Quasi⁃Natural Experiment on Public Hospital Reform

医院竞争是医疗体制改革的大趋势,现阶段医疗供需矛盾日益突出,医院竞争对患者福利的影响不容忽视。本文构建了医院决策和患者就诊的动态博弈模型,研究了提高医院竞争程度对患者福利的影响及微观作用机制,并分析不同的竞争性医疗需求对医院竞争与患者福利关系的作用。通过双重差分方法,利用第二批公立医院改革的准自然实验对医院竞争影响患者福利的效果进行验证,研究发现,医院竞争对患者的福利水平具有显著的促进作用。机制分析表明,在公立医院改革的过程中,医院竞争在没有明显提高医疗价格的情况下主要通过改善医疗质量、降低交通费用影响患者福利。调节效应分析显示,在竞争性医疗需求越高的医疗市场中,医院竞争对患者福利的提升效果越大。本文为医疗体制改革背景下中国医疗产业竞争政策如何满足患者的医疗需求、提升福利水平提供了理论支持。

A series of hospital competition policies have been proposed in the healthcare system reform in China.Do they bring more benefits to patients and meet their rising demand for health services?This question triggers a major debate in healthcare and economics,and the answer to this question affects the future direction of competition policy in the healthcare industry.Constructing a dynamic game model on hospital decision⁃making and patient access,this paper investigates the impact and micro mechanism of intensifying hospital competition in the form of increasing the number of hospitals and reducing the transport cost per visit on patient welfare and examines the effect of different competitive healthcare demands.Then,the effect of hospital competition on patient welfare is validated by a quasi⁃natural experiment of the second public hospital reforms through difference⁃in⁃differences(DID)approach.It is found that hospital competition significantly reduces patients'spending on visits and improves health outcomes and satisfaction with life,in other words,hospital competition increases patient welfare.Mechanism analysis shows that hospital competition enhances patient welfare mainly by improving the healthcare quality and reducing transportation costs.In addition,hospital competition has a greater effect on patient welfare in markets with higher competitive demand for healthcare.This study contributes to the extant research in three ways.Firstly,this paper is an early study about the relationship between hospital competition and patient welfare in China's healthcare market,examining the welfare effects of hospital competition in the current healthcare reform from the perspective of empirical analysis,and providing corresponding theoretical support for the future direction of competition policy in China's healthcare industry.Secondly,the paper extends the micro analysis mechanisms of the effect of hospital competition on patient welfare by constructing a dynamic game model in the healthcare market.Thirdly,this paper enriches the measurement of patient welfare by analyzing patients'subjective welfare and examines the changes in patient welfare in a more comprehensive manner.This study provides theoretical support for how competition policies in China's healthcare industry can meet patients'healthcare needs and enhance welfare in the context of healthcare system reform.The following recommendations are made.Hospital competition policies should continue to be refined so as to create a favorable institutional environment for hospitals to engage in deeper competition.The design of hospital competition policies should be optimized so that more areas can be covered in these policies.Differentiated competing healthcare needs in the healthcare market should be considered and efforts should be made to ensure that hospital competition policies deliver tangible benefits for patients.