Impact of a New Case-Based Payment Scheme on Volume Distribution Across Public Hospitals in China: Does 'Same Disease, Same Price' Matter

Abstract

Background In China, the disparity in patient distribution across hospitals of varying levels is largely caused by fee-for-service (FFS) payment. To reduce this inequality, an innovative payment called “payment method by disease types with point counting” was launched in Zhejiang province, and was later integrated with “same disease, same price” policy. This study aimed to investigate the impact of this payment on service volume distribution across Chinese public hospitals. Methods Data was obtained from 104 hospitals, with 12 tertiary and 14 secondary hospitals extracted from each of the four regions: intervention groups in Jinhua and Hangzhou, and control groups in Taizhou and Ningbo. Using a total of 3848 observation points, two sets of controlled interrupted time series analyses were performed to evaluate the impact of this new case-based payment with and without “same disease, same price” on the proportion of discharges, total medical revenue and hospitalization revenue, as well as Herfindahl-Hirschman Index (HHI). Results After the introduction of the new case-based payment without “same disease, same price”, the proportion of discharges (β₆=-0.1074, p = 0.047), total medical revenue (β₆=-0.0729, p = 0.026) and hospitalization revenue (β₆=-0.1062, p = 0.037) of secondary hospitals significantly decreased. Despite no statistical significance, the proportion in tertiary hospitals increased. By incorporating “same disease, same price”, the proportion of discharges (β₆ = 0.2015, p = 0.031), total medical revenue (β₆ = 0.1101, p = 0.041) and hospitalization revenue (β₆ = 0.1248, p = 0.032) of secondary hospitals increased, yet differences in tertiary hospitals were insignificant. The HHI (β₇ = 0.0011, p = 0.043) presented an upward trend during the pilot period of this payment without “same disease, same price”, while after the implementation of this payment combined with “same disease, same price”, the HHI (β₆=-0.0234, p = 0.021) decreased immediately. Conclusion This new case-based payment scheme does not promote rational volume distribution among different-level hospitals, yet “same disease, same price” may help. Policymakers should balance interests of hospitals when devising payment mechanisms, and regulate providers’ potential strategic behavior.