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Can a global budget improve health care efficiency? Experimental evidence from China.
Zhang, Hao; Zhang, Luying; Xu, Roman; Pan, Jay; Hu, Min; Jian, Weiyan; Yip, Winnie.
Afiliación
  • Zhang H; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
  • Zhang L; School of Public Health, Fudan University, Shanghai, China.
  • Xu R; SMU Insitute for Global Health and School of Health Management, Southern Medical University, Guangzhou, China.
  • Pan J; HEOA Group, West China School of Public Health, Sichuan University, Chengdu, China.
  • Hu M; School of Public Health, Fudan University, Shanghai, China.
  • Jian W; Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
  • Yip W; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
Health Econ ; 31(8): 1676-1694, 2022 08.
Article en En | MEDLINE | ID: mdl-35608001
Health care in China suffers from substantial allocative inefficiency in the delivery system and technical inefficiency within hospitals. To ameliorate this problem in rural areas, the Analysis of Provider Payment Reforms on Advancing China's Health (APPROACH) project shifted the payment method of China's rural health insurance scheme for county hospitals from fee-for-service to a novel global budget. In particular, APPROACH global budget incentivized system-level allocative efficiency by reimbursing county hospitals at higher tariffs for gatekeeping and averting out-of-county (OOC) admissions among local patients they could treat. APPROACH conducted a large-scale randomized controlled trial of the global budget in 56 counties (22 million enrollees) of Guizhou province during 2016-2017. Applying randomization inference to claims data, we find a significant shift of inpatient utilization and expenditure from OOC hospitals to county hospitals. At county hospitals, average expenditure per admission and length of stay decreased, though not significantly. Effects on readmissions show no clear sign of compromised quality. We further find limited effect heterogeneity with respect to treatment and hospital characteristics. Overall, APPROACH global budget may offer a framework for improving health care efficiency without sacrificing quality.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Presupuestos / Gastos en Salud Tipo de estudio: Clinical_trials / Health_economic_evaluation País/Región como asunto: Asia Idioma: En Revista: Health Econ Asunto de la revista: SERVICOS DE SAUDE Año: 2022 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Presupuestos / Gastos en Salud Tipo de estudio: Clinical_trials / Health_economic_evaluation País/Región como asunto: Asia Idioma: En Revista: Health Econ Asunto de la revista: SERVICOS DE SAUDE Año: 2022 Tipo del documento: Article