国家组织冠脉支架带量集采对患者医疗负担的影响  

The Impact of National Volume-Based Coronary Stent Procurement on Patients’Healthcare Costs

作　　者：孙雅 刘智勇[2] 殷婷 提俊琛 Sun Ya;Liu Zhiyong;Yin Ting;Ti Junchen

机构地区：[1]华中科技大学经济学院 [2]华中科技大学医药卫生管理学院,湖北省武汉市430030 [3]日本经济产业研究所

出　　处：《世界经济》2024年第10期124-151,共28页The Journal of World Economy

基　　金：社会科学基金青年项目(21CJY023);华中科技大学文科双一流建设项目基金(张培刚研究院建设项目);中央高校基本科研业务费专项资金(2024WKCG012)的资助。

摘　　要：本文利用断点回归设计和医疗行政数据评估国家组织冠脉支架带量集采政策对患者医疗负担的影响,为带量集采政策的实施效果提供直接证据,也为高值医用耗材集采进一步常态化和制度化提供了重要政策参考。研究结果显示,在冠脉支架带量集采后,医院为应对利润损失,提高了心脏病介入手术数量,同时增加了影像学检查使用率和药物球囊等尚未受集采影响的高值耗材使用,这一现象在三级医院更加明显。因此,在冠脉支架带量集采后,心脏病患者入院平均总费用和自付金额并未如预期般下降。本文研究结论表明,医生供方诱导需求是患者医疗负担高居不下的重要原因,单一产品的价格管制无法抑制过度医疗,且可能造成新的福利损失。This paper uses a regression discontinuity design(RDD)and healthcare administrative data to assess the impact of the national volume-based coronary stent procurement policy on patients’healthcare burden.The results indicate that,following centralised procurement of coronary stents,in response to loss in profits,hospitals increase the number of coronary surgeries,as well as the use of imaging tests and high-value consumables,such as drug-coated balloons,which have not yet been affected by the centralised procurement policy.This phenomenon is more evident in tertiary hospitals.As a result,the average total cost and out-of-pocket expenditure do not decrease.The findings suggest that the physician-induced demand is one of the main reasons for the high medical burden on patients.Price controls on a single product cannot reduce excessive medical treatment and may even lead to further welfare losses.

关 键 词：带量集中采购 冠脉支架 诱导需求 以械养医 

分 类 号：F426.4[经济管理—产业经济] R197.32[医药卫生—卫生事业管理]