Analysis on the Impact of Medical Insurance Reform and Innovation on Outpatient and Inpatient Services: Taking Jinhua as an Example

Corresponding author: tuo hong wu, tuohongwu@163.com

DOI: 10.12201/bmr.202502.00051

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  Abstract: Objective: This study empirically analyzes the relationship between outpatient and inpatient services under the impact of healthcare payment reform, and evaluates the effects of the reform. Methods: Data from healthcare services and basic medical insurance payments in eight districts of Jinhua City from 2020 to 2022 were used. A fixed-effects model for outpatient and inpatient services was constructed to analyze the impact of healthcare payment reforms and outpatient services on inpatient services. Results: The DRG-based payment had a significant positive effect on inpatient visits and a significant negative effect on employee basic medical insurance inpatient costs. The capitation + APG outpatient payment policy had a significant negative effect on inpatient visits and a significant negative effect on residents basic medical insurance inpatient costs. The interaction between outpatient payment and outpatient visits had a significant negative effect on employee basic medical insurance inpatient visits, while the interaction between outpatient payment and outpatient costs had a significant negative effect on both overall and employee inpatient costs. Conclusion: The DRG payment reform led to an increase in inpatient visits and a reduction in employee basic medical insurance inpatient costs. The outpatient capitation + APG payment reform reduced inpatient visits and lowered residents basic medical insurance inpatient costs, thereby slowing down the complementary effect between outpatient and inpatient services.

  Key words: Outpatient coordination; Ambulatory patient groups; Capitation bundled payment; Policy package

  Submit time: 24 February 2025

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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