Impact of a health system vertical integration program on patient expenditures and healthcare utilization: Evidence from county hospitals in East China

IF 5.2 1区经济学 Q1 ECONOMICS

中国经济评论 Pub Date : 2024-08-13 DOI:10.1016/j.chieco.2024.102250

Wei Jiang , Qiulin Chen , Xuyan Lou , Lina Song , Zhuo Chen

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Abstract

In 2009, China launched a vertical integration pilot program to promote collaboration between tertiary and county hospitals to reduce rural-urban disparities and strengthen capacity building in healthcare services delivery in county healthcare facilities. Through the program, tertiary hospitals implemented a workforce mobility program to temporarily assign selected physicians and healthcare staff to paired county hospitals. This study uses hospital-level data from 2009 to 2015 to investigate the program's impact on medical expenditures and healthcare utilization among patients visiting the paired county hospitals. A difference-in-differences method with hospital and year-fixed effects is used to address the unobservable heterogeneity of hospitals and the potential impact of national healthcare reform. We find that the average outpatient expenditure experienced a 4.0% decline after the county hospitals received paired assistance from tertiary hospitals. The decline is mainly driven by a reduced proportion of diagnostic testing expenditures. However, there is no evidence that the program affected inpatient expenditures. In addition, county hospitals had 5.1% more outpatient visits after receiving paired assistance, while the average length of stay remains stable. These results are robust when we control the effect of the Zero-Markup drug policy and conduct permutation tests of sample assignment. We conclude that the paired assistance program has successfully improved hospital healthcare services delivery and controlled patient expenditures. Vertical integration has improved healthcare system performance in East China from 2009 to 2015.

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医疗系统纵向整合项目对患者支出和医疗利用率的影响：来自华东地区县级医院的证据

2009 年，中国启动了纵向一体化试点项目，以促进三级医院与县级医院的合作，缩小城乡差距，加强县级医疗机构的医疗服务能力建设。通过该项目，三级医院实施劳动力流动计划，将选定的医生和医护人员临时派往结对的县级医院。本研究利用 2009 年至 2015 年的医院层面数据，调查了该计划对结对县级医院就诊患者的医疗支出和医疗利用率的影响。研究采用了带有医院和年份固定效应的差分法，以解决医院的不可观测异质性和国家医疗改革的潜在影响。我们发现，县级医院接受三级医院结对帮扶后，平均门诊支出下降了 4.0%。下降的主要原因是诊断检测支出比例的降低。然而，没有证据表明该项目影响了住院支出。此外，县级医院在接受配对援助后，门诊量增加了 5.1%，而平均住院时间保持稳定。当我们控制零加成药品政策的影响并对样本分配进行排列检验时，这些结果是稳健的。我们的结论是，配对援助计划成功地改善了医院医疗服务的提供并控制了患者支出。从 2009 年到 2015 年，垂直整合改善了华东地区的医疗系统绩效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

中国经济评论 ECONOMICS-

CiteScore

10.60

自引率

4.40%

发文量

380

期刊介绍： The China Economic Review publishes original works of scholarship which add to the knowledge of the economy of China and to economies as a discipline. We seek, in particular, papers dealing with policy, performance and institutional change. Empirical papers normally use a formal model, a data set, and standard statistical techniques. Submissions are subjected to double-blind peer review.