Top-up Design and Health Care Expenditure: Evidence from Cardiac Stents
2020/03/17
研討會日期 : 2020-03-17
時間 : 14:30
主講人 : Professor Hsienming Lien (連賢明)
主持人 : Professor Tzu-Ting Yang
地點 : Conference Room B110
演講者簡介 : Professor Lien received his Ph.D. in Economics from Boston University in 2002. He is currently a Professor at National Chengchi University His research interests are Health Economics, Industrial Organization, and Applied Econometrics.
演講摘要 : Taiwan’s National Health Insurance (NHI) has adopted a top-up design for cardiac stents since 2007: the NHI covers the full cost of baseline treatment (bare-metal stents); but if a patient prefers more expensive treatments (drug-eluting stents), she must pay for the incremental cost out of pocket. Such a “top-up” coverage has been advocated as a good model to provide essential care for the mass population and keep the cost of health care under control. To further reduce health spending, the NHI cut the reimbursement rate of bare-metal stents (to hospitals) by 26% in January 2009. We study how hospitals responded to this price change and how such response affects the actual payment from the NHI and patients. Based on individual patient records and hospital-reported stent prices (2007-2010), we find no evidence of hospitals raising the price of drug-eluting stents. However, on average hospitals increase the number of stents per admission by 0.14 in 2009, and most of the increases are for bare metal stents. As a result, the rate cut induces about 18% more BMS usage and providers recoup up to 30% of the revenue loss in 2009 after the NHI rate cut. This suggests that the rate cut is still effective in reducing NHI expenditure on cardiac stents, despite hospital moral hazard.
