IDEAS home Printed from https://ideas.repec.org/p/nbr/nberwo/28107.html
   My bibliography  Save this paper

Top-up Design and Health Care Expenditure: Evidence from Cardiac Stents

Author

Listed:
  • Ginger Zhe Jin
  • Hsienming Lien
  • Xuezhen Tao

Abstract

Since 2006, Taiwan's National Health Insurance (NHI) has covered the full cost of baseline treatment in cardiac stents (bare-metal stents, BMS). Still, it requires patients to pay the incremental cost of more expensive treatments (drug-eluting stents, DES). Within this “top- up” design, we study how hospitals responded to a 26% cut of the NHI reimbursement rate in 2009. We find that hospitals that were more revenue reliant on cardiac patients increased BMS usage per stent patient by 0.05 or 6% but not DES usage. In addition, while the average of DES prices remains almost unchanged, minor teaching hospitals that were more revenue reliant on cardiac patients raised the DES price by 12.6%, and therefore could recoup at most 32.7% of the revenue loss from the NHI rate cut in 2009-2010. Overall, the rate cut was effective in reducing NHI expenditure without any substantial changes in patient outcomes, although some minor teaching hospitals made moral hazard adjustments in response.

Suggested Citation

  • Ginger Zhe Jin & Hsienming Lien & Xuezhen Tao, 2020. "Top-up Design and Health Care Expenditure: Evidence from Cardiac Stents," NBER Working Papers 28107, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:28107
    Note: IO
    as

    Download full text from publisher

    File URL: http://www.nber.org/papers/w28107.pdf
    Download Restriction: no
    ---><---

    More about this item

    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nbr:nberwo:28107. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/nberrus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.