Cost Sharing and Cost Shifting Mechanisms under a per Diem Payment System in a County of China
Abstract
:1. Introduction
2. Institutional Background
3. Data and Methods
3.1. Data
3.2. Methods
4. Results
4.1. Difference-in-Differences Estimates on the Reform Impacts
4.2. Robustness Check with Dynamic Estimates
4.3. Heterogeneous Effects on Medical Costs and LOS
5. Discussions
Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Medical Costs | |
---|---|
Reform | −0.0384 (0.0561) |
Gender | −0.0198 ** (0.0083) |
Age | 0.0157 *** (0.0033) |
Age2 | −0.0001 *** (0.0000) |
LOS | 0.0888 *** (0.0056) |
Control variables | Yes |
Hospital fixed effects | Yes |
Time fixed effects | Yes |
N | 28,021 |
adj. R2 | 0.609 |
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Whole | Control Group | Reform Group | ||||
---|---|---|---|---|---|---|
Mean | S.D. | Mean | S.D. | Mean | S.D. | |
Gender | 0.55 | 0.50 | 0.54 | 0.50 | 0.57 | 0.50 |
Age | 58.74 | 14.12 | 56.89 | 15.38 | 61.05 | 11.97 |
LOS | 7.56 | 2.72 | 7.60 | 3.34 | 7.53 | 1.64 |
Medical costs | 1078.04 | 688.37 | 1187.79 | 815.71 | 940.19 | 446.30 |
Medical Costs | LOS | |
---|---|---|
Reform | −0.1759 *** (0.0186) | 0.0249 (0.0448) |
Gender | −0.0135 *** (0.0050) | −0.0300 *** (0.0069) |
Age | 0.0138 *** (0.026) | −0.0061 *** (0.0019) |
Age2 | −0.0001 *** (0.0000) | −0.0001 *** (0.0000) |
LOS | −0.0915 *** (0.0049) | |
Disease variables | Yes | Yes |
Hospital fixed effects | Yes | Yes |
Time fixed effects | Yes | Yes |
n | 69,480 | 69,480 |
adj. R2 | 0.582 |
(1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | (10) | |
---|---|---|---|---|---|---|---|---|---|---|
OLS | Q10 | Q20 | Q30 | Q40 | Q50 | Q60 | Q70 | Q80 | Q90 | |
Reform | −0.1759 *** | −0.1072 *** | −0.1359 *** | −0.1500 *** | −0.1667 *** | −0.1814 *** | −0.1975 *** | −0.2114 *** | −0.2250 *** | −0.2287 *** |
(0.0135) | (0.0109) | (0.0089) | (0.0079) | (0.0073) | (0.0068) | (0.0070) | (0.0070) | (0.0070) | (0.0091) | |
Control variables | YES | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Hospital fixed effects | YES | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Time fixed effects | YES | YES | YES | YES | YES | YES | YES | YES | YES | YES |
N | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 |
(1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | (10) | |
---|---|---|---|---|---|---|---|---|---|---|
Poisson | Q10 | Q20 | Q30 | Q40 | Q50 | Q60 | Q70 | Q80 | Q90 | |
Reform | 0.0249 | 0.1795 *** | 0.1458 *** | 0.1246 *** | 0.1038 *** | 0.0866 *** | 0.0670 *** | 0.0318 *** | −0.0339 *** | −0.1050 *** |
(0.0448) | (0.0060) | (0.0035) | (0.0037) | (0.0040) | (0.0049) | (0.0045) | (0.0059) | (0.0086) | (0.0120) | |
Control variables | YES | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Hospital fixed effects | YES | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Time fixed effects | YES | YES | YES | YES | YES | YES | YES | YES | YES | YES |
N | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 | 69,480 |
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Liu, F.; Chen, J.; Li, C.; Xu, F. Cost Sharing and Cost Shifting Mechanisms under a per Diem Payment System in a County of China. Int. J. Environ. Res. Public Health 2023, 20, 2522. https://doi.org/10.3390/ijerph20032522
Liu F, Chen J, Li C, Xu F. Cost Sharing and Cost Shifting Mechanisms under a per Diem Payment System in a County of China. International Journal of Environmental Research and Public Health. 2023; 20(3):2522. https://doi.org/10.3390/ijerph20032522
Chicago/Turabian StyleLiu, Fengrong, Jiayu Chen, Chaozhu Li, and Fenghui Xu. 2023. "Cost Sharing and Cost Shifting Mechanisms under a per Diem Payment System in a County of China" International Journal of Environmental Research and Public Health 20, no. 3: 2522. https://doi.org/10.3390/ijerph20032522