医保总额控制对医疗费用的影响-中国社会保障学会.pdf

信达生物制药（苏州）有限公司 观察思考 医保总额控制对医疗费用的影响 ——基于上海和成都的研究 1 1 2 封 进 唐 珏 马 勇 1 2 （复旦大学经济学院 上海 200433; 中国医疗保险研究会 北京 100716） 我国医保付费总额控制已在全国85%的统筹区实施，本文探讨这一管理措施对医院行为和医疗费用的 【摘要】 影响。以上海和成都为研究对象，采用城职保参保人住院服务利用数据，本文发现，这一政策下，两城市月均住院费 用在一年中呈现明显的“前低后高”的趋势，年底压缩住院天数的现象并不严重，医院有撑大第二年医保盘子的考虑。 总额控制使得成都次均住院费用下降6.7%，但对三级医院次均费用并没有影响，费用下降的主要是非三级医院。此 外，对于次均费用较高的病种费用下降较为显著，费用较低的病种的降费效果并不明显。 医保总额控制；费用周期性；医保控费效果 【关键词】 F840.684 C913.7 A 1674-3830 （2019 ） 6-15-4 【中图分类号】 【文献标识码】 【文章编号】 doi:10.19546/j.issn.1674-3830.2019.6.004 Effect of Medical Insurance Total Budget Control on Health Care Costs——Based on 1 1 2 1 Shanghai and Chengdu Feng Jin ,Tang Jue ,Ma Yong ( School of Economics, Fudan University, Shanghai, 2 200433; China Medical Insurance Research Association, Beijing, 100716) The total budget payment system has been adopted in 85% regions of social medical insurance 【Abstract 】 in China. This paper evaluates the effects on hospital behavior and heath care expenditure using administrative data from Shanghai and Chengdu. We find that under total budget payment system, there is a “tight first and loose afterwards” cycle for inpatient care expenditure. There is no obvious evidence of reducing length of stay at the end of a year, the possible reason for which is that the hospital has incentive to increase the budget of the next year. The total budget payment system reduced the inpatient expenditure per time by 6.7%. The effect is