Ming Chen1, Yan Guo. 1. Department of Health Policy and Administration, Peking University School of Public Health, Beijing, China.
Abstract
OBJECTIVE: To find out whether single disease payment system would have an impact on hospital delivery service providers' behavior. METHODS: Zhouzhi County in Shaanxi Province where there was a payment change from fee for service (FFS) to single disease payment in 2007 was selected as the treatment group, and Guangling County in Shanxi Province with FFS was selected as the control group. Using a difference-in-difference (DD) design, this study empirically examined the impact of single disease payment on the cost of hospital delivery and length of stay. The data of 1 050 samples were taken from the hospitalization medical records and list of charges in the hospitals between 2005-11-01 and 2010-12-31. RESULTS: When taking the expense as dependent variable, the estimated value of DD variable was -262.73 with parity, length of stay, delivery mode, and payment controlled, which was significant at the 1‰ level. It indicated that the expense had decreased by 262.73 yuan after single disease payment was introduced. When taking the length of stay as dependent variable, the estimated value of DD variable was 0.53, which was not significant at the 5% level,meaning that the length of stay was not different between single disease payment and FFS. CONCLUSION: The payment change from FFS to single disease payment has an impact on hospital delivery service providers' behavior. It could make hospitals try their best to reduce the expenses under the price ceiling to avoid paying for the exceeding cost, and it also can restrict induced demand, but it could not motivate hospitals to reduce length of stay. This research provides evidence for policy makers that compared with FFS, single disease payment system is an effective payment method for controlling the expense of hospital delivery under the new cooperative medical scheme (NCMS) and the policy of subsidy for rural hospital delivery (SRHD) .
OBJECTIVE: To find out whether single disease payment system would have an impact on hospital delivery service providers' behavior. METHODS: Zhouzhi County in Shaanxi Province where there was a payment change from fee for service (FFS) to single disease payment in 2007 was selected as the treatment group, and Guangling County in Shanxi Province with FFS was selected as the control group. Using a difference-in-difference (DD) design, this study empirically examined the impact of single disease payment on the cost of hospital delivery and length of stay. The data of 1 050 samples were taken from the hospitalization medical records and list of charges in the hospitals between 2005-11-01 and 2010-12-31. RESULTS: When taking the expense as dependent variable, the estimated value of DD variable was -262.73 with parity, length of stay, delivery mode, and payment controlled, which was significant at the 1‰ level. It indicated that the expense had decreased by 262.73 yuan after single disease payment was introduced. When taking the length of stay as dependent variable, the estimated value of DD variable was 0.53, which was not significant at the 5% level,meaning that the length of stay was not different between single disease payment and FFS. CONCLUSION: The payment change from FFS to single disease payment has an impact on hospital delivery service providers' behavior. It could make hospitals try their best to reduce the expenses under the price ceiling to avoid paying for the exceeding cost, and it also can restrict induced demand, but it could not motivate hospitals to reduce length of stay. This research provides evidence for policy makers that compared with FFS, single disease payment system is an effective payment method for controlling the expense of hospital delivery under the new cooperative medical scheme (NCMS) and the policy of subsidy for rural hospital delivery (SRHD) .