Impact of Provider Competition under Global Budgeting on the Use of Cesarean Delivery

Chen, Bradley; Chen, Chin-Shyan; Liu, Tsai-Ching

doi:10.1111/1475-6773.12668

Cited by 5 publications

(4 citation statements)

References 44 publications

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“…Additionally, medical expenditure dropped sharply after the GBPS was fully implemented, whereas the GBPS pilot showed no statistically significant changes. Previous research also showed that the GBPS had a more prominent impact in changing physician behavior in larger general hospitals [32,34]. This may be because tertiary hospitals have more methods to control for expenditure, such as shifting inpatients to secondary and primary hospitals.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the Global Budget Payment System on Expenditure of Cardiovascular Diseases: An Interrupted Time Series Analysis in Shanghai, China

Dou

Zhang

et al. 2019

IJERPH

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Since few studies evaluated the impact of the global budget payment system (GBPS) over time, and by expenditure type, this paper aims to evaluate the impact of the GBPS on expenditure of inpatients, and explores how hospitals curb the expenditure in patients with cardiovascular diseases (CVDs) in Shanghai. We built a time series model with the monthly expenditure of CVDs from 2009 to 2012. We evaluated the instant impact and trends impact of the GBPS and analyzed results based on medical expenditure types (e.g., drug, examination, cure, unclassified items), discharge number, and expenditure per capita. We found GBPS instantly dropped the medical expenditure by Chinese Yuan (CNY) 55.71 million (p < 0.001), and decreased the monthly increasing trend by CNY 4.23 million (p = 0.011). The discharge number had 10.4% instant reduction and 225.55 monthly decrease (p = 0.021) while the expenditure per capita experienced fewer changes. Moreover, the expenditure of drug and cure had an instant reduction of CNY 28.31 million and 16.28 million (p < 0.001). In conclusion, we considered the GBPS is an effective solution to control the expenditure of CVDs by decreasing the discharge number, and a focus on the drug and cure expenditures lead to greater spend reduction than other types of expenditures.

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Section: Discussionmentioning

confidence: 99%

“…Tertiary hospitals in Shanghai make up 70.87% of the total medical expenditure among healthcare institutions. Based on the theory of expected income, they consequently have a greater ability to undertake loss associated with the GBPS [34,35].…”

Section: Discussionmentioning

confidence: 99%

Impact of the Global Budget Payment System on Expenditure of Cardiovascular Diseases: An Interrupted Time Series Analysis in Shanghai, China

Dou

Zhang

et al. 2019

IJERPH

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“…The total actual reimbursement to Hospital A is then $1.9 million ($1 million + 0.6 * $1.5 million) and to Hospital B is $2.1 million ($1.5 million + 0.6 * $1 million). Thus, although hospitals competing for a share of the GBS will have an incentive to overprovide all services (Chen, Chen, & Liu, 2018;Chen & Fan, 2015;Fan, Chen, & Kan, 1998;Hsu, 2014), this incentive may be particularly strong for sheltered services, given their fixed reimbursement rates.…”

Section: Sheltered Services Within a Global Budgetmentioning

confidence: 99%

Provider responses to a global budgeting system: The case of drug expenditures in Taiwan hospitals

Dearden

Deily

Lien³

2020

Health Economics

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In July 2002, a global budgeting system was imposed on hospitals in Taiwan. This system set a fixed budget for all hospitals within a region but included special provisions that sheltered reimbursements for drug expenditures. We study the size and nature of changes in hospital physicians' use of drugs for outpatient care following this budgetary change and find that drug expenditures for outpatient care increased by 11.7%. Our results suggest that physicians began prescribing more expensive drugs, more drugs, and drugs for longer periods but that these different responses did not all occur at the same time. The overall response was strongest in for‐profit hospitals, but drug‐related decisions changed in all hospital types.

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“…The existing researches on RGB-FPS have some limitations. First, many studies focus on the micro performance of diseases but less on the macro performance of hospitals after the implementation of RGB-FPS [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Theoretical and empirical studies have revealed that RGB-FPS may lead hospitals to increase service volume by attracting patients from other hospitals and hospitalization decomposition [ 4 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

The Response of Different-Levels Public Hospitals to Regional Global Budget with a Floating Payment System: Evidence from China

Zhong

Jiang

2022

IJERPH

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Background: Regional Global Budget with a Floating Payment System (RGB-FPS) is a global budget widely used in medical insurance payments. However, existing studies on hospitals’ responses to RGB-FPS have limitations. First, existing studies have paid little attention to RGB-FPS’s macro effects. Theoretical studies did not analyze differences between different levels of hospitals. Secondly, studies did not reveal whether RGB-FPS has the same impact on the public-hospital-dominated market. Methods: First, we refine the research hypotheses through theoretical analysis. We then test the hypotheses empirically through interrupted time series analysis. Results: Theoretical analysis found that small hospitals were easier to transfer costs. The empirical analysis found that after RGB-FPS, the proportion of inpatients (PI)and the average times of inpatients in large hospitals increased (p < 0.001), and the proportion of non-reimbursable expenses (PNE) remained stable (p > 0.05). PI in secondary hospitals decreased (p < 0.01), and PNE increased (p < 0.01). PI in the primary hospital decreased (p < 0.05), and PNE increased (p < 0.001). Conclusion: This study verifies theoretically and empirically that large hospitals are easier to increase service volume and small hospitals are easier to transfer costs under the influence of RGB-FPS. Chinese public hospitals’ response to RGB-FPS is similar to that of private hospitals.

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Impact of Provider Competition under Global Budgeting on the Use of Cesarean Delivery

Abstract: While global budgeting is an effective cost containment tool, intensified financial pressures may lead to unintended consequences of compromised quality due to a shift in provider practice in pursuit of financial rewards.

Cited by 5 publications

References 44 publications

Impact of the Global Budget Payment System on Expenditure of Cardiovascular Diseases: An Interrupted Time Series Analysis in Shanghai, China

Impact of the Global Budget Payment System on Expenditure of Cardiovascular Diseases: An Interrupted Time Series Analysis in Shanghai, China

Provider responses to a global budgeting system: The case of drug expenditures in Taiwan hospitals

The Response of Different-Levels Public Hospitals to Regional Global Budget with a Floating Payment System: Evidence from China

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