主题 / Topic：Structure of Government Health Spending, Physician Remuneration, and Continuous Medical Cost Escalation in China: A Mixed-Method Investigation
时间 / Time：5月26号（周五）｜May 26 (Friday), 14：00- 15：30
地点 / Venue：文波 207｜207，WENBO
主讲 / Speaker
刘凯博士，中国人民大学劳动人事学院社会保障系讲师。本科毕业于南开大学，硕士和博士毕业于香港中文大学，曾获富布莱特青年学者奖学金，于哈佛大学和加州大学伯克利分校从事学术交流活动，主要研究领域包括卫生政策、医疗保障和比较社会保障制度。以第一作者或共同作者身份在《中国社会科学》《social science & medicine》《International Journal of Social Welfare》等期刊发表论文，著有学术专著一部。主持国家社会科学基金青年项目一项。
研究领域 / Research Interests
卫生政策、医疗保障和比较社会保障制度
Health Policy, Health Care and Social Security System Comparison
摘要 / Abstract
The macro spending structure of government health budget changes in the waning and waxing of spending on health facilities and on health insurance programs. How do the manner and area in which government health spending realigns incentives for healthcare Providers and affects medical cost inflation in the Chinese context is an important question of significant policy relevance but remains unanswered. Employing a mixed-method design, this study used provincial-level panel data and examined the association between the share of government health spending on health facilities and medical costs through the mediating role of physicians’ salaries in China. It further used a qualitative thematic analysis to illustrate individual physicians’ attitudes and prescribing behaviors in response to government’s contribution to their salary. The quantitative study found that the macro spending structure of government health budget shifted its focus from investing health facilities to subsidizing health insurance in China in the past decade. The share of government health expenditure on health facilities had an inverse indirect association with medical cost inflation, through the mediation of salary of medical staff. The qualitative study elucidated a prevalent dissatisfaction of physician towards poor remuneration as well as the tiny contribution the government made to their incomes. As such, physicians in both hospitals and primary facilities resorted to a variety of cost-shifting behaviors to make up the shortfall in their incomes, thus vigorously inflating costs. This study suggests that supply-side underfunding may exacerbate demand inducement and further inflate total costs. In order to realize a holistic management of incentives for physicians, it is necessary to adjust macro spending structure of government health funding to gain tactical support from supply side.
