The impact of medical insurance payment reform on medical services and costs:A case study of Jinhua
10.3969/j.issn.1674-2982.2025.01.006
- VernacularTitle:医保支付方式改革对医疗服务及费用的影响分析
- Author:
Miao YU
1
;
Ze-yao LI
;
Hong-wu TUO
;
Yan-sui YANG
;
Guan-pin WU
;
Hua-qiang JIN
;
Xiao-zhou JIANG
Author Information
1. 清华大学基础医学院 北京 100084
- Publication Type:Journal Article
- Keywords:
Risks pooling of outpatient services;
Ambulatory patient groups payment;
Capitation
- From:
Chinese Journal of Health Policy
2025;18(1):43-50
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study empirically analyzes the relationship between outpatient and inpatient services under the impact of healthcare payment reform,and evaluates the effects of the reform.Methods:Data from healthcare services and basic medical insurance payments in eight districts of Jinhua City from 2020 to 2022 were used.A fixed-effects model for outpatient and inpatient services was constructed to analyze the impact of healthcare payment reforms and outpatient services on inpatient services.Results:The DRG-based payment had a significant positive effect on inpatient visits and a significant negative effect on employee basic medical insurance inpatient costs.The"capitation+APG"outpatient payment policy had a significant negative effect on inpatient visits and a significant negative effect on residents'basic medical insurance inpatient costs.The interaction between outpatient payment and outpatient visits had a significant negative effect on employee basic medical insurance inpatient visits,while the interaction between outpatient payment and outpatient costs had a significant negative effect on both overall and employee inpatient costs.Conclusions:The DRG payment reform led to an increase in inpatient visits and a reduction in employee basic medical insurance inpatient costs.The outpatient"capitation+APG"payment reform reduced inpatient visits and lowered residents'basic medical insurance inpatient costs,thereby slowing down the complementary effect between outpatient and inpatient services.
