Modeling individual health care expenditures in China: Evidence to assist payment reform in public insurance.
Health Econ
; 27(12): 1945-1962, 2018 12.
Article
em En
| MEDLINE
| ID: mdl-30044018
ABSTRACT
Reforming the payment system of public health insurance from fee-for-service to more efficient alternative schemes has become an urgent policy issue in developing countries. Using a large sample of administrative data drawn from China, we examine a variety of econometric models for predicting the medical expenditures of individuals. We show that the standard ordinary least squares model performs relatively well compared with other models. We then propose two alternative payment schemes on risk-adjusted capitation. The first is a prospective capitation model and the second incorporates both prospective and retrospective features. We simulate the corresponding payments based on model predictions and evaluate the payment/cost ratios for health care providers. The results show that the prospective capitation method generates smaller financial fluctuation, suggesting that policymakers may prefer this method to achieve a smooth transition.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Mecanismo de Reembolso
/
Modelos Econométricos
/
Gastos em Saúde
/
Setor Público
/
Seguro Saúde
Tipo de estudo:
Health_economic_evaluation
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
País/Região como assunto:
Asia
Idioma:
En
Revista:
Health Econ
Assunto da revista:
SERVICOS DE SAUDE
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
China