The Study Of Supply-Side Moral Hazard Under Medical Insurance Payment Reform

With the development of social economy,the intensification of aging process and the gradual expansion of health insurance coverage,the rapidly increasing medical expenses have become one of the main challenges facing the reform of China's medical and health care system.The key to effectively controlling the excessive rise of medical expenditures,improving the efficiency of medical resources and ensuring the sustainability of medical insurance funds lies in whether the reform of medical insurance payment methods can be effectively promoted.Since the new round of medical and health system reform in 2009,China has issued a series of documents to promote medical insurance payment reform,emphasizing the gradual establishment of a multifaceted and complex medical insurance payment method based on payment by disease type and diagnosis-related groups.However,different health insurance payment methods have their own advantages and disadvantages,and they have different constraints and incentives for medical providers,and thus have different impacts on medical provider moral hazard.Analyzing the impact of moral hazard of medical suppliers under different medical insurance payment methods is conducive to deepening the reform of medical insurance payment methods and reducing the unreasonable increase of medical costs.Based on a large sample of micro data of medical institutions and patients combined in a sub-provincial city in China,this paper systematically investigates the impact of different health insurance payment methods on the moral risk of medical suppliers by using a combination of theoretical and empirical analysis,and provides empirical evidence and policy recommendations to promote the reform of health insurance payment methods and improve the efficiency of health insurance fund use.The main research ideas are as follows: firstly,we compile and summarize relevant theories and literature,and grasp the current situation and frontier methods of domestic and foreign research;secondly,we analyze the performance and mechanism of medical supplier moral risk under different medical insurance payment methods,and explore the changing trend of medical supplier moral risk in the context of the current situation and development process of medical insurance payment reform in China;thirdly,based on empirical data,we analyze the moral risk of medical suppliers from multiple perspectives,such as medical cost and medical quality.Based on the empirical data,we analyze the impact of item-based payment,total prepayment,single-patient fixed payment and per-patient group value payment on the moral risk of medical suppliers;finally,we summarize the findings and propose corresponding policy recommendations,and look forward to the development of this paper.The research and main findings of this paper are as follows:First,under the item-based post-payment system,medical providers discriminate against patients with different types of health insurance based on the degree of disease.First,the medical costs of urban and rural patients are higher than those of urban and rural patients,and the difference between the costs of urban and rural patients increases with the increase of disease heterogeneity.Secondly,the cost of drugs and medical treatment is more influenced by the degree of disease heterogeneity among patients with different types of medical insurance,while the cost of medical treatment is less influenced by the degree of disease heterogeneity among patients with different types of medical insurance.Finally,as the degree of disease heterogeneity increased,urban-occupational insured patients paid more for medical insurance reimbursement but less for out-of-pocket expenses than urbanrural insured patients.Second,under the prepayment method of total control,medical providers have the behavior of adjusting medical resources across time.First,after the implementation of the total prepayment policy,medical providers are not careful enough to use the budget amount in the first period,which leads to the tight budget amount in the later period.Secondly,the number of days patients stay in the hospital decreases in the later part of the budget adjustment year,and the cost of medical treatment decreases in the perspective.Again,the number of visits to medical institutions declined in the later part of the budget year,and there was a phenomenon of shifting patients.Finally,after the implementation of the total prepayment policy,the quarterly cycle effect of reimbursement for patients visiting secondary and primary hospitals is greater,and the cycle adjustment effect of reimbursement for patients with "common diseases" and urban and rural patients is more obvious.Third,under the single-patient prepayment system,the pilot providers were subject to strategic behaviors such as shifting patients,reducing the probability of surgery,and increasing patient comorbidities,and non-pilot providers were also affected by the policy,i.e.,there were "spillover effects.Specifically,after the implementation of the single-patient flat-rate payment policy in the pilot institutions,the structure of patient visits to the institutions changed,with the number of visits decreasing by about half,the total cost of care and the probability of surgery for patients covered by single-patient categories decreasing significantly,and the probability of comorbidities increasing significantly.In addition,the length of stay of patients covered by the single-category policy increased significantly in non-pilot facilities compared to the length of stay of patients covered by the other categories,and similarly,the one-month readmission rate and three-month readmission rate increased significantly.And after the implementation of the single-patient fixed-rate payment policy,the probability of surgery for single-patient-covered patients in non-pilot hospitals increased significantly compared with that for patients covered by other conditions.Fourth,under the prepayment system of payment by value of patient group,medical suppliers may have strategic behaviors such as changing patient treatment plan and breaking up hospitalization.First,it significantly reduces the total medical costs,drug costs,examination costs,treatment costs and consumables costs of inpatients,with the largest decrease in examination costs.Second,the value-based payment reform had an impact on the quality of medical services.The value-based payment reform increased the two-week readmission rate and the one-month readmission rate of patients,and reduced the probability of patients having surgery.Finally,tertiary and primary care providers were more likely to change their medical service behavior in the face of the per-patient value-based payment reform,resulting in changes in medical costs and quality of care.Based on the above findings,this paper finds that medical provider moral hazard exists in both prepaid and postpaid payment methods,and the manifestation of medical provider moral hazard varies among different medical insurance payment methods.Therefore,policy makers should summarize the advantages and disadvantages of various payment methods,take into account the complexity and diversity of patients' access and treatment,and actively promote the reform of multiple and complex health insurance payment methods.In addition,they should set scientific and reasonable health insurance payment standards,adjust them dynamically in real time,and improve the monitoring and incentive mechanisms for medical providers,so as to improve their efficiency and regulate their medical service behaviors.