This seminar will present the results of the recently completed randomized impact evaluation of a provider payment project carried out in county hospitals in the rural areas of Guizhou province in China. This project switched the local rural health insurance - the New Rural Cooperative Medical Scheme (NCMS) - from fee-for-service payments for county hospitals to a global budget scheme in order to incentivize hospitals to act as gatekeepers, minimize out-of-county (OOC) referrals and reduce unnecessary expenditures for county hospital-based treatment. The intervention was implemented in two waves.
Results indicate variable impact. For one set of intervention counties/hospitals, the results show that the provider payment intervention led to reduced OOC admissions. This finding is consistent with the government’s objective to build a “tiered delivery” system in China, that is, less complicated cases should be shifted from tertiary hospitals to secondary hospitals as a way to improve allocative efficiency. There is also some evidence to suggest that faced with a global budget, hospitals cost shift by prescribing more services/drugs that are not eligible for NCMS reimbursement, thus leading to increased out-of-pocket spending. This effect is weaker for hospitals of which NCMS payment represents a significant share of the hospitals’ revenue. We did not find evidence that the payment intervention led hospitals to improve their managerial capability, as measured by the World Management Survey instrument.
Meeting number: 172 241 4812
Meeting password: wVJUuehB548
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Photo credit: UNICEF/UNI315089/Yuwei