公立医院专项财政补助对患者医疗费用负担的影响理论模型与实证研究
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摘要
目的分析政府专项财政补助对医院平均医疗费用的影响。方法建立公立医院行为理论模型,并以上海市三级医院数据为基础,利用面板模型开展实证研究。结果研究结果显示,如果同时对公立医院实施价格管制和财政补助,在医疗服务限价低于边际成本的情况下,政府专项财政补助的增加反而会推高医疗平均费用。结论政府专项财政补助的增加,一方面会通过分担公立医院的固定成本降低医疗费用,另一方面会因增加医疗设备设施而可能加剧诱导需求进而推高医疗费用,政府专项财政补助对医疗费用的影响取决于两种效应的大小比较,而医疗服务定价水平对两种效应的关系有显著影响。建议在增加专项补助的同时,合理确定医疗服务的价格,优化公立医院补偿机制。
Objective To analyze the impact of special government subsidies on the average hospital medical expenses. Methods A theoretical model of the behaviors of public hospitals was established. Based on the data from tertiary hospitals in Shanghai, an empirical analysis was performed using a panel model. Results When both price regulation and financial subsidies were applied in a public hospital, the increase in special government subsidies would increase the average expenditure of medical care if the price limits for medical services were below the marginal cost. Conclusion While the increase in special government subsidies can reduce medical expenses by sharing the fixed costs of public hospitals, it can also raise the medical expenses due to induced medical demands following the purchasing of new medical equipment. The impact of government special financial subsidies on medical expenses depends on the degree of these two effects, and the pricing of medical services has a significant impact on the relationship between these two effects. When the special subsidies are increased, the price of medical services should be reasonably determined and the compensation mechanism of public hospitals should be optimized.
Objective To analyze the impact of special government subsidies on the average hospital medical expenses. Methods A theoretical model of the behaviors of public hospitals was established. Based on the data from tertiary hospitals in Shanghai, an empirical analysis was performed using a panel model. Results When both price regulation and financial subsidies were applied in a public hospital, the increase in special government subsidies would increase the average expenditure of medical care if the price limits for medical services were below the marginal cost. Conclusion While the increase in special government subsidies can reduce medical expenses by sharing the fixed costs of public hospitals, it can also raise the medical expenses due to induced medical demands following the purchasing of new medical equipment. The impact of government special financial subsidies on medical expenses depends on the degree of these two effects, and the pricing of medical services has a significant impact on the relationship between these two effects. When the special subsidies are increased, the price of medical services should be reasonably determined and the compensation mechanism of public hospitals should be optimized.
引文
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[2]Frank A,Sloan.Chapter 21 Not-for-profit ownership and hospital behavior.Handbook of Health Economics,2000,1141-1174.
[3]李玲,陈秋霖,张维,等.公立医院的公益性及其保障措施[J].中国卫生政策研究,2010,3(5):7-11.
[4]刘继同.卫生财政学概念的涵义、范围领域、基本特征与地位作用[J].中国卫生经济,2008,7(3):1-3.
[5]俞卫.公立医院改革:公益性、财政补偿和治理模式[J].中国卫生政策研究,2011,4(7):25-27.
[6]赵大海.政府对公立医院财政投入的水平和方式研究[J].财政研究,2010,2:7-9.
[7]朱恒鹏,昝馨,向辉.财政补偿体制演变与公立医院去行政化改革[J].经济学动态,2014,12:61-71.
[8]杨顺心,代涛,黄菊.财政补助对县级公立医院经济运行的影响:基于试点县的实证分析[J].中国卫生经济,2016,1:10-13.
[9]冀路肖,杨金侠.安徽省县级公立医院次均住院费用影响因素分析[J].中国卫生统计,2017,34(6):925-927.
[10]刘凯,和经纬.“补供方”与“补需方”对医疗费用的影响比较——基于三明市新医改的实证研究[J].北京行政学院学报,2017,6:10-17.
[11]杨帆,裴敬,罗增永.我国医疗服务定价体系相关问题探讨[J].中国医疗管理科学,2015,5(6):14-17.
[12]Pauly M,Redisch M.The not-for-profit hospital as a physicians'cooperative[J].The American Economic Review,1973(63):87-99.
[13]Chang T,Jacobson M.What do nonprofit hospitals maximize?evidence from California's seismic retrofit mandate.Working Paper,2012.
[14]Evans R.Supplier-induced demand:some empirical evidence and implications[J].Economics of Health&Medical,1974:162-173.
[15]Newhouse J.Towards a theory of nonprofit institutions:an economic model of a hospital[J].American Economic Review,1969,60(1):64-74.
[16]Wooldridge JM.Econometric analysis of cross section and panel data[M].Second Edition.The MIT Press,2010.
[17]Vaisey S,Miles A.What you can-and can't-do with threewave panel data.Working papers of Duke University.2012.