ArticleInternational journal of environmental research and public health2023
Cost Sharing and Cost Shifting Mechanisms under a per Diem Payment System in a County of China.
Article in International journal of environmental research and public health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Beyond average costs: large-scale evidence on DRG payment reform and the distribution of standardized inpatient spending in China.Health economics review · 2026Article
- Do non-local hospitalized patients cost more? A comparative study based on the implementation of the DRG payment.Frontiers in public health · 2026Article
- Development and validation of dual-time-window readmission prediction models under China's medical insurance multi-payment reform.Frontiers in public health · 2026Article
- Impact of per diem payment on medical expenditure, service efficiency, and quality of care for patients with mental disorders: an interrupted time series study.BMC health services research · 2025Article
- Neurosurgery 4.0: A Scoping Review of Current Trends and Challenges in Specialized Smart Hospitals.Cureus · 2025Review
- Cost shifting or cost cutting by hospitals as a response to reimbursement reform? The case of diagnosis-related groups (DRG) scheme in China.Frontiers in public health · 2025Article
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Authors and funding
4 authors.
Funding
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Abstract
Cost sharing and cost shifting mechanisms are of vital importance in a prospective payment system. This paper employed the difference-in-differences method to estimate the impacts of a per diem system with inverted-U-shape rates on medical costs and the length of stay based on data from a health insurance institution. The supply side cost sharing mechanism worked so that the new payment system significantly reduced medical costs by 17.59 percent while the average length of stay varied little. After further analyzing the mechanism, we found that heterogeneous effects emerged mainly due to the special rates design. The reform decreased the cases that incurred relatively high medical costs and lengths of stay. However, cost shifting existed so that physicians could be motivated to provide unnecessary services to the patients who should have been discharged before the average length of stay. Therefore, payment rates in the per diem system require a sophisticated design to constrain its distortion to medical service provision even though medical expenditures were successfully contained.
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