Economics Department and CEDEPLAR-UFMG, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Economics Department, Insper - Institute of Education and Research, São Paulo, São Paulo, Brazil.
Int J Health Econ Manag. 2024 Mar;24(1):57-80. doi: 10.1007/s10754-023-09361-0. Epub 2023 Sep 10.
Brazil's private health insurance market is the second largest in the world, behind only the United States, making it a valuable source of real-world evidence. This paper documents how physicians' inpatient reimbursement fees vary in the country and explores the relationship between these fees and the market share of health providers and health insurance companies. We implement a fixed-effects panel regression and take advantage of an unprecedented database that contains national administrative records of inpatient procedures paid by health insurance companies in 2016. We find a positive correlation between reimbursement for ICU procedures and provider market share. Conversely, we observe a negative correlation with insurers' market share. Additionally, we document substantial variation in procedure prices, both across and within Brazilian states, and observe that more competitive markets in Brazil tend to have higher population and GDP levels. Overall, our research enhances our understanding of the price setting dynamics of physician reimbursement fees in the context of a developing country. The insights gained from this study can assist policymakers in formulating appropriate regulations to ensure appropriate access to healthcare services.
巴西的私人医疗保险市场是世界第二大市场，仅次于美国，这使其成为真实世界证据的重要来源。本文记录了巴西医生住院报销费用的差异，并探讨了这些费用与医疗服务提供商和医疗保险公司市场份额之间的关系。我们采用固定效应面板回归，并利用一个前所未有的数据库，该数据库包含了保险公司在 2016 年支付的住院程序的国家行政记录。我们发现，重症监护室程序的报销与提供者市场份额呈正相关。相反，我们观察到与保险公司市场份额呈负相关。此外，我们记录了程序价格在巴西各州之间和内部的巨大差异，并观察到巴西竞争更激烈的市场往往具有更高的人口和 GDP 水平。总的来说，我们的研究增强了我们对发展中国家医生报销费用定价动态的理解。本研究的结果可以帮助政策制定者制定适当的法规，以确保获得适当的医疗服务。
