School of Insurance, Southwestern University of Finance and Economics, Chengdu, China.
School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China.
BMC Health Serv Res. 2021 May 25;21(1):501. doi: 10.1186/s12913-021-06525-x.
Price regulation is a common constraint in Chinese hospitals. Based on a policy experiment conducted in China on the price deregulation of private nonprofit hospitals, this study empirically examines the impact of medical service price regulation on the pricing of medical services by hospitals.
Using the claim data of insured inpatients residing in a major Chinese city for the period 2010-2015, this study constructs a DID (difference-in-differences) model to compare the impact of price deregulation on medical expenditure and expenditure structure between public and private nonprofit hospitals.
The empirical results based on micro data reveal that, price deregulated significantly increased the total expenditure per inpatient visit by 10.5%. In the itemized expenditure, the diagnostic test and drug expenditure per inpatient visit of private nonprofit hospitals decreased significantly, whereas the physician service expenditure per inpatient visit increased significantly. For expenditure structure, the proportions of drug expenditure and diagnostic test expenditure per inpatient visit significantly decreased by 5.7 and 3.1%, respectively. Furthermore, this paper also found that hospitals had larger price changes for dominant diseases than for non-dominant diseases.
Under price regulation, medical service prices generally become lower than their costs. Therefore, after price deregulation, private nonprofit hospitals increase medical service prices above their cost and achieve the service premium increasing physician medical services. Further, although price deregulation causes patient expenditure to increase to a certain level, it optimizes the expenditure structure, as well.
价格管制是中国医院的常见限制。本研究基于中国对非营利性私立医院医疗服务价格放松管制的政策实验，实证检验了医疗服务价格管制对医院医疗服务定价的影响。
利用中国一个主要城市参保住院患者的理赔数据，本研究构建了一个双重差分（DID）模型，以比较价格放松管制对公立医院和非营利性私立医院医疗支出和支出结构的影响。
微观数据的实证结果表明，价格放松管制显著增加了每位住院患者的总支出 10.5%。在分项支出中，非营利性私立医院的每例住院患者的诊断测试和药品支出显著下降，而每例住院患者的医师服务费支出显著增加。对于支出结构，每例住院患者的药品支出和诊断测试支出的比例分别显著下降 5.7%和 3.1%。此外，本文还发现，医院对优势病种的价格变化大于对非优势病种的价格变化。
在价格管制下，医疗服务价格普遍低于成本。因此，价格放松管制后，非营利性私立医院将医疗服务价格提高到成本以上，并实现了服务溢价，增加了医师的医疗服务。此外，尽管价格放松管制导致患者支出在一定程度上增加，但也优化了支出结构。
