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中国公立三甲医院供方诱导需求的新证据:淡季的住院费用是否更高?

New evidence on supplier-induced demand in China's public tertiary hospitals: is the cost of hospitalization higher in the off-season?

机构信息

School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China.

School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China.

出版信息

Eur J Health Econ. 2024 Aug;25(6):951-962. doi: 10.1007/s10198-023-01638-y. Epub 2023 Nov 3.

Abstract

Supplier-induced demand (SID) is a long-standing concern in health economics and health system studies; however, empirical evidence on SID-critical to the development of health policy-is difficult to obtain, especially from China. This study, therefore, aims to add new evidence on SID in China's public tertiary hospitals and facilitates the development of evidence-based health policies in China and other countries with similar healthcare systems. For this study, we used patient-level electronic medical records (EMRs) collected from the information systems of tertiary hospitals in a western province in China. From 11 tertiary hospitals, we collected 274,811 hospitalization records dated between 15 February and 30 November 2019. Total expenditure on hospitalization and length of admission of each patient were the primary metrics for measuring SID. We constructed a character indicator to measure the high-season or off-season status of hospitals, and log-linear estimations were applied to estimate the "off-season effect" on hospitalized expenditures and length of admission. We find that the cost of hospitalization is indeed higher in the off-season in China's public tertiary hospitals; specifically, expenditures for patients admitted in the off-season increased by an average of 5.3-7.9% compared to patients admitted in the peak season, while the length of admission in the hospital increased by an average of 6.8% to 10.2%. We also checked the robustness of our findings by performing subgroup analyses of EMRs in the city-level hospitals and surgical group. We name this phenomenon the "hospital off-season effect" and suggest that the main reason for it is inappropriate financial incentives combined with a Fee-For-Services payment method. We suggest that China should work to reform inappropriate financial incentives in public hospitals to eliminate SID by changing its payment and financing compensation system.

摘要

供应商诱导需求(SID)是卫生经济学和卫生系统研究中长期存在的问题;然而,SID 的实证证据对于制定卫生政策至关重要,而这方面的证据很难从中国获得。因此,本研究旨在为中国公立三甲医院的 SID 提供新的证据,并为中国和其他具有类似医疗体系的国家制定基于证据的卫生政策提供便利。在这项研究中,我们使用了从中国西部一个省份的三甲医院信息系统中收集的患者级电子病历(EMR)。我们从 11 家三甲医院收集了 2019 年 2 月 15 日至 11 月 30 日期间的 274811 份住院记录。住院总费用和每位患者的住院时间是衡量 SID 的主要指标。我们构建了一个字符指标来衡量医院的旺季或淡季状态,并应用对数线性估计来估计医院淡季对住院费用和住院时间的“淡季效应”。我们发现,中国公立三甲医院的住院费用确实在淡季更高;具体来说,与旺季入院的患者相比,淡季入院的患者住院费用平均增加了 5.3%至 7.9%,而住院时间平均增加了 6.8%至 10.2%。我们还通过对市级医院和外科组的 EMR 进行亚组分析来检查我们发现的稳健性。我们将这种现象称为“医院淡季效应”,并认为其主要原因是不当的财务激励措施与按服务收费的支付方式相结合。我们建议中国应努力改革公立医院的不当财务激励措施,通过改变其支付和融资补偿制度来消除 SID。

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