Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, H80, 10623, Berlin, Germany.
Eur J Health Econ. 2019 Sep;20(7):1029-1039. doi: 10.1007/s10198-019-01056-z. Epub 2019 May 29.
This paper empirically investigates the impact of additional reimbursement instruments on the diffusion of new technologies in inpatient care. Using 2010-2014 German panel data on hospital level for every patient undergoing coronary angioplasty, this study examines the utilisation of drug-eluting balloon catheters (DEB) over time while additional payment instruments changed. Hypothesising that the utilisation of DEB increased abruptly when a new reimbursement instrument came into force, we estimate a fixed effects regression comparing years with a change and years where the reimbursement instrument remained the same. The model is adjusted for patient age and severity of the disease. The utilisation of DEB increased from 8407 in 2010 to 19,065 in 2014. Hospitals used significantly more DEB when an additional payment instrument changed compared to years when it remained the same. The increase was roughly twice as large. In short, hospitals are incentivised to utilise new technologies if the reimbursement changes to an instrument that is designed in a more reliable way, e.g. including less bureaucracy or guaranteeing fixed prices.
本文通过实证研究，考察了额外的报销工具对住院治疗中新技术扩散的影响。本文使用了 2010-2014 年德国关于每位接受冠状动脉成形术的患者的医院层面的面板数据，研究了随着额外支付工具的变化，药物洗脱球囊导管（DEB）的使用随时间的变化情况。本文假设当一种新的报销工具生效时，DEB 的使用会突然增加，因此我们通过比较有变化的年份和没有变化的年份，对固定效应回归进行了估计。该模型根据患者年龄和疾病严重程度进行了调整。2010 年 DEB 的使用量为 8407 例，2014 年增加到 19065 例。与支付工具保持不变的年份相比，当支付工具发生变化时，医院使用 DEB 的数量明显增加。增加幅度大约是原来的两倍。简而言之，如果报销方式发生变化，使用一种设计更可靠的支付工具，例如减少官僚主义或保证固定价格，医院就会有激励去使用新技术。
