School of Risk & Actuarial Studies & CEPAR, The University of New South Wales, 223 Anzac Parade, Sydney, NSW, 2052, Australia.
UNSW Ageing Futures Institute, The University of New South Wales, 223 Anzac Parade, Sydney, NSW, 2052, Australia.
BMC Health Serv Res. 2020 Dec 3;20(1):1118. doi: 10.1186/s12913-020-05895-y.
Doing "more" in healthcare can be a major threat to the delivery of high-quality health care. It is important to identify the supplier-induced demand (SID) of health care. This study aims to test SID hypothesis by comparing health care utilization among patients affiliated with healthcare professionals and their counterpart patients not affiliated with healthcare professionals.
We used coarsened exact matching to compare the health care utilization and expenditure between patients affiliated and not affiliated with healthcare professionals. Using cross-sectional data of the China Labour-force Dynamics Survey (CLDS) in 2014, we identified 806 patients affiliated with healthcare professionals and 22,788 patients not affiliated with healthcare professionals. The main outcomes were outpatient proportion and expenditure as well as inpatient proportion and expenditure.
The matched outpatient proportion of patients not affiliated with healthcare professionals was 0.6% higher (P = 0.754) than that of their counterparts, and the matched inpatient proportion was 1.1% lower (P = 0.167). Patients not affiliated with healthcare professionals paid significantly more (680 CNY or 111 USD, P < 0.001) than their counterparts did per outpatient visit (1126 CNY [95% CI 885-1368] vs. 446 CNY [95% CI 248-643]), while patients not affiliated with healthcare professionals paid insignificantly less (2061 CNY or 336 USD, P = 0.751) than their counterparts did per inpatient visit (15583 CNY [95% CI 12052-19115] vs. 17645 CNY [95% CI 4884-30406]).
Our results lend support to the SID hypothesis and highlight the need for policies to address the large outpatient care expenses among patients not affiliated with healthcare professionals. Our study also suggests that as the public becomes more informed, the demand of health care may persist while heath care expenditure per outpatient visit may decline sharply due to the weakened SID. To address misbehaviors and contain health care costs, it is important to realign provider incentives.
在医疗保健领域“做得更多”可能是提供高质量医疗保健的主要威胁。确定供方诱导需求（SID）非常重要。本研究旨在通过比较与医疗保健专业人员有关联的患者和没有与医疗保健专业人员有关联的患者的医疗保健利用情况来检验 SID 假设。
我们使用粗化精确匹配来比较与医疗保健专业人员有关联和没有与医疗保健专业人员有关联的患者的医疗保健利用和支出。我们使用 2014 年中国劳动力动态调查（CLDS）的横截面数据，确定了 806 名与医疗保健专业人员有关联的患者和 22788 名没有与医疗保健专业人员有关联的患者。主要结果是门诊比例和支出以及住院比例和支出。
与医疗保健专业人员没有关联的患者的匹配门诊比例高出 0.6%（P=0.754），而匹配住院比例低出 1.1%（P=0.167）。与医疗保健专业人员没有关联的患者每次门诊就诊支付的费用明显更多（680 元或 111 美元，P<0.001），而与医疗保健专业人员没有关联的患者每次住院就诊支付的费用明显更少（2061 元或 336 美元，P=0.751）。
我们的结果支持 SID 假设，并强调需要制定政策来解决与医疗保健专业人员没有关联的患者的高额门诊费用问题。我们的研究还表明，随着公众获得更多信息，需求可能会持续存在，而由于 SID 减弱，每次门诊就诊的医疗保健支出可能会大幅下降。为了解决不当行为和控制医疗保健成本，重要的是要重新调整提供者的激励措施。
