制度激励:医保支付方式改革的医疗资源配置效应  

Institutional Incentives:Healthcare Resource Allocation Effect of Health Insurance Payment Reform

作　　者：向迪 倪晨旭 王震[2] XIANG Di;NI Chen-xu;WANG Zhen(School of Economics,University of Chinese Academy of Social Sciences,Beijing 102488;Institute of Economics,Chinese Academy of Social Sciences,Beijing 100836,China)

机构地区：[1]中国社会科学院大学经济学院,北京102488 [2]中国社会科学院经济研究所,北京100836

出　　处：《统计学报》2025年第2期79-94,共16页Journal of Statistics

基　　金：国家社会科学基金项目(20ZDA043)。

摘　　要：基于医疗机构面板数据,评估DRG医保支付方式改革对医疗资源配置的影响。研究发现:改革通过调整支付激励机制,有效重构了医疗服务供给结构,使资源配置从“重住院、轻门诊”向更均衡模式转变;具体效应表现为门诊服务量提升、住院服务量下降,同时住院次均费用降低,医疗成本结构优化(检查与化验费用占比下降)。科室异质性分析显示,内科替代效应更显著,而儿科等特殊科室面临激励适配不足问题。这些发现为分级诊疗体系建设与价值医疗导向下的医保支付制度优化提供了实证依据。Using panel data from healthcare institutions,this paper evaluated the impact of Diagnosis-Related Group(DRG)payment reform on healthcare resource allocation.The study found that the reform effectively restructured healthcare service provision by realigning payment incentives,shifting resource allocation from an“inpatient-heavy,outpatient-light”model toward greater balance.Specifically,the reform promoted outpatient service utilization but reduced inpatient admissions and per-admission costs,while optimizing cost structures through lower proportions of examination and laboratory expenses.Heterogeneity analysis revealed that substitution effects were more pronounced in internal medicine compared to specialty departments,such as pediatrics,where incentive alignment remained insufficient.These findings provided empirical supports for the development of tiered healthcare systems and the optimization of value-based payment mechanisms.

关 键 词：医保支付方式 DRG 资源配置 分级诊疗 价值医疗 双重差分 医疗体制改革 公立医院 

分 类 号：R197.1[医药卫生—卫生事业管理]