School of Economics and Finance, South China University of Technology, Guangzhou, China.
School of Accounting, Guangdong University of Foreign Studies, Guangzhou, China.
Int J Health Econ Manag. 2022 Sep;22(3):257-294. doi: 10.1007/s10754-021-09318-1. Epub 2021 Nov 13.
In October 2015, the Guangdong government of China enacted a so-called unified medical insurance payment for patients residing in Guangdong province, which fundamentally simplifies reimbursement procedures of medical insurance for the involved cross-city in-patients. Using a unique confidential dataset from 2013 to 2018 on hemorrhoid treatments at a renowned hospital in Guangzhou, the provincial capital of Guangdong, and exploiting difference-in-differences estimations based on the abovementioned policy, we document that the physicians' incentives are a negative externality of the full medical insurance policy for cross-city in-patients and account for a 49% probability increase in improper treatments; and neither increasing the communication between physicians and patients nor enhancing the education level of patients reduces the physician-induced demand for improper treatments. A series of robustness tests indicate our findings are solid. In summary, we highlight the substantial roles of medical insurance as a driver of physician-induced demand in an emerging economy such as China.
2015 年 10 月，中国广东省政府颁布了一项所谓的“全省统一医保支付”政策，该政策从根本上简化了跨市住院患者的医保报销手续。本研究利用了来自广东省省会广州市一家知名医院 2013 年至 2018 年治疗痔疮的独特保密数据集，并基于上述政策进行了双重差分估计，结果表明，医生的激励机制是跨市住院患者全面医保政策的一个负外部性，会导致不当治疗的可能性增加 49%；增加医患沟通和提高患者教育水平都不能减少医生诱导的不当治疗需求。一系列稳健性检验表明，我们的研究结果是可靠的。总之，我们强调了医疗保险在中国等新兴经济体中作为医生诱导需求驱动因素的重要作用。
