Eggleston Karen, Yip Winnie
Department of Economics, Tufts University, Braker Hall, Medford, MA 02155, USA.
Int J Health Care Finance Econ. 2004 Dec;4(4):343-68. doi: 10.1023/B:IHFE.0000043762.33274.4f.
We develop a model of public-private hospital competition under regulated prices, recognizing that hospitals are multi-service firms and that equilibria depend on the interactions of patients, hospital administrators, and physicians. We then use data from China to calibrate a simulation model of the impact of China's recent payment and organizational reforms on cost, quality and access. Both the analytic and simulation results show how providing implicit insurance through distorted prices leads to over/under use of services by profitability, which in turn fuels cost escalation and reduces access for those who cannot afford to self-pay for care. Simulations reveal the benefits of mixed payment and expanded insurance cover for mitigating these distortions.
我们构建了一个在价格管制下的公私医院竞争模型，认识到医院是提供多种服务的企业，且均衡取决于患者、医院管理人员和医生之间的相互作用。然后，我们利用来自中国的数据校准了一个模拟模型，以评估中国近期支付和组织改革对成本、质量和就医机会的影响。分析和模拟结果均表明，通过扭曲价格提供隐性保险如何导致按盈利能力过度/不足使用服务，进而推动成本上升，并减少那些无力自费就医者的就医机会。模拟结果揭示了混合支付和扩大保险覆盖范围在减轻这些扭曲方面的益处。
