Effect Evaluation Of Medical Service Price Adjustment Policy On Medical Cost

After China carried out reform and open policy,it has a great progress in the field of health,but this results in rapidly unreasonable growth of medical cost which reduces the efficiency of the allocation of medical resources,the availability of medical services and the problem of inadequate and overly expensive medical services.In order to solve this problem.China in 2000 had implemented health system reform which put forward the" total control and structural adjustment of medical cost" approach.The specific measures were to adjust the unreasonable medical service price and drug price and reduce inspection fees to control medical cost.In 2009 in order to deepen the reform of the medical and health system and eliminate the mechanism of "drug-maintaining-medicine",China gradually withdrew the policy of drug price addition,and adjusted medical service price and increased government investment to ensure the sustainable development of hospitals.However,theoretically,the relationship between the medical service price adjustment and medical cost are still lack of systematic thinking.And domestic scholars had no consistent results of the policy effect evaluation of the two medical service price adjustment.This thesis combs the relevant research literatures,and based on the balance-budget theory of the hospital income,this study set up the Bootstrap method,the fixed effect model and the mediation effect model by using panel data of 31 provinces(municipalities and autonomous regions)from 2002 to 2015.Therefore the effects of the two medical service price adjustment on the per capita and total medical cost and the total number of patients in the outpatient and inpatient are analyzed.And the medical cost structure(the proportion of drugs,inspection and medical services)as a mediator variable can be investigated internal mechanism.And we come to the conclusion.Firstly,the first medical service price adjustment significantly can reduce the total medical cost and the total number of outpatients and inpatients,but have no significant effect on the per capita medical cost of outpatients and inpatients;the second medical service price adjustment have no significant effect.Secondly,the first medical service price adjustment can significantly reduce the proportion of outpatient and inpatient drugs and the proportion of inpatient medical services.And it can also increase the proportion of outpatient and inpatient inspection and the proportion of outpatient medical services;the second medical service price adjustment can significantly reduce the proportion of inpatient drugs.Thirdly,the first medical service price adjustment can have an influence on per capita medical cost of outpatients through the mediation effect of the medical cost structure,but the effect is not significant.But it has significant direct effect on the total medical cost and number of outpatients through significantly partial mediation effect of the medical cost structure;the second medical service price adjustment only has mediation effect of the proportion of drugs,and the direct effect is not significant.Finally,the first medical service price adjustment affects the per capita medical cost of inpatients through the complete mediation effect of the medical cost structure.And it also significantly reduces the total medical cost of inpatients by the partial mediation effect of the proportion of medical services and the complete mediating effect of the proportion of inspection;the second medical service price adjustment can reduce the number of inpatients through the masking effect of the proportion of drug.In view of the above conclusions,it can be concluded that medical cost can be controlled by reducing the proportion of drugs and inspection and increasing the proportion of medical services.But it need be supplemented by the relevant policies.Firstly,financial subsidies should be in place in time,and according to the level and size of hospitals they should be given by the differential subsidies;Secondly,it should rationalize medical service price and reduce inspect fees.Thirdly,it should strictly manage the procurement and use of drug.Fourthly,it should improve the efficiency of medical resources utilization.Finally,it should reform the method of medical insurance payment.