The Spillover Effects of a City-Wide Global Budget and Case-Based Payment Reform on Inbound Non-Resident Patients

IF 2.4 3区 医学 Q2 ECONOMICS
Health economics Pub Date : 2025-06-14 DOI:10.1002/hec.4979
Yawen Jiang
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引用次数: 0

Abstract

This study investigates the spillover effects of a city-wide global budget and case-based payment reform (known as the DIP reform) on non-resident patients from another city in the same province. By developing a theoretical model, I hypothesize that nontrivial deviation costs from reform-driven standard patient journeys could lead to reduced charges for patients who seek care in the reform city but are not subject to its payment reform policies. To test this hypothesis, I employ a difference-in-differences approach using discharge records to compare outcomes between patients from a non-reform outbound city hospitalized in the reform city, where DIP was implemented, and those hospitalized in other non-reform cities within the same province. The results indicate that the DIP reform significantly reduced total hospital charges for non-resident patients, without compromising care quality as measured by readmission rates. Notably, high-cost hospitals experienced more pronounced charge reductions compared to low-cost hospitals, highlighting the need to manage heterogeneous impacts on different healthcare providers to ensure equitable healthcare delivery.

城市范围内的全球预算和案例支付改革对入境非居民患者的溢出效应。
本研究调查了全市范围内基于预算和病例的全球支付改革(称为DIP改革)对来自同一省另一个城市的非居民患者的溢出效应。通过建立一个理论模型,我假设,改革驱动的标准患者旅程的重大偏离成本可能导致在改革城市寻求治疗但不受其支付改革政策约束的患者的费用降低。为了检验这一假设,我采用了一种差异中的差异方法,使用出院记录来比较在实施DIP的改革城市住院的非改革出境市患者与在同一省份其他非改革城市住院的患者之间的结果。结果表明,DIP改革显着降低了非居民患者的医院总收费,而不影响以再入院率衡量的护理质量。值得注意的是,与低成本医院相比,高成本医院的收费下降更为明显,这突出表明需要管理对不同医疗保健提供者的异质性影响,以确保公平的医疗保健服务。
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
Health economics
Health economics 医学-卫生保健
CiteScore
3.60
自引率
4.80%
发文量
177
审稿时长
4-8 weeks
期刊介绍: This Journal publishes articles on all aspects of health economics: theoretical contributions, empirical studies and analyses of health policy from the economic perspective. Its scope includes the determinants of health and its definition and valuation, as well as the demand for and supply of health care; planning and market mechanisms; micro-economic evaluation of individual procedures and treatments; and evaluation of the performance of health care systems. Contributions should typically be original and innovative. As a rule, the Journal does not include routine applications of cost-effectiveness analysis, discrete choice experiments and costing analyses. Editorials are regular features, these should be concise and topical. Occasionally commissioned reviews are published and special issues bring together contributions on a single topic. Health Economics Letters facilitate rapid exchange of views on topical issues. Contributions related to problems in both developed and developing countries are welcome.
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