The Impact of Capitation Reform on Overuse and Healthcare Expenditure——Based on the Primary Care Facilities'Data of District Y of X City in Western China
Based on the capitation reform of medical insurance in primary care,using the anonymous standard-ized patient(USP)method to collect data on overuse and healthcare expenditure in primary care facilities dur-ing the initial and deepening periods of capitation reform in 2019 and 2021 and applying the Randomization Inference Differences-in-Differences(RI-DID)model,the objective of this paper is to investigate the impact of capitation reform on overuse and healthcare expenditure in primary care and to explore the mechanism of the reform.We found that compared to the baseline,the implementation of capitation reform significantly reduced the per capita total costs,test costs,and drug costs for USPs in the treatment group.Nextly,despite the fact that the motivation for doctors to provide overuse of medical services and tests still exists after the reform,the capitation reform has brought economic incentives for doctors to enjoy the surplus of capitation fees and bear the economic risk of overspending without reimbursement.The capitation reform also assesses the quantity and quality of healthcare services provided by doctors.Therefore,the competition and conflict between doctors'pro-vision of overuse of medical services and the reduction of medical costs will always exist,which is manifested in the"competition effect",that is,the mutual interaction of the"income effect"and the"substitution effect".Under the combined effect of the two,the occurrence and extent of overuse of medical services and tests pro-vided by doctors were weakened,which led to further reductions in the total costs and test costs,in line with the expectations of the capitation reform.The conclusions of this paper provide insights for advancing the hier-archical diagnosis and treatment,as well as designing relevant programs and supporting policies for primary healthcare payment reform and quality improvement under the"14th Five-Year Plan"health development goals.
Healthcare ReformCapitationOveruse of HealthcareHealthcare ExpenditureMedical Insurance
万方数据
维普
