Effects of Hospital Payment Reform of Government Budget Allocation and Social Health Insurance in a Pilot in China

Document Type : Original Article

Authors

1 School of Public Health, Peking University, Beijing, China

2 China Center for Health Development Studies, Peking University, Beijing, China

3 Shenzhen Health Development Research and Data Management Center, Shenzhen, China

4 Vanke School of Public Health, Tsinghua University, Beijing, China

Abstract

Background 
Government budget allocation (GBA) and social health insurance (SHI) constitute the primary revenue sources for public hospitals in China, with GBA accounting for a substantially smaller proportion compared to SHI. Starting in 2015, a megacity in southern China gradually introduced payment reforms. GBA, previously based on government approved number of staff (input-based), was replaced with an output-based model. Subsequently, SHI payment method was changed from fee-for-service (FFS) to case-based payment.
 
Methods 
The study adopted a staggered difference-in-differences (DiD) model to assess the effects of reforms on service volume and capacity, as well as hospital efficiency. We used hospital-level panel data of 29 hospitals in the city from 2009 to 2022.
 
Results 
The GBA reform increased annual outpatient visits by 301 374 per hospital (P < .01) and promoted efficiency (score increase of 0.02, P < .05). In contrast, the SHI reform increased annual inpatient discharges by 2417 per hospital (P < .05) but had no significant effect on efficiency (-0.15, P > .1).
 
Conclusion 
The output-based GBA reform increased outpatient service volume and the number of healthcare professionals, while the case-based SHI reform raised inpatient discharges. Only GBA was associated with a modest efficiency gain given the distinct incentives of GBA and SHI. Future research should explore strategies for better alignment of multiple funding streams, such as unified purchasing with blended payment models or clearer functional differentiation. 

Keywords

References

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History

  • Received Date: 06 November 2024
  • Revised Date: 02 August 2025
  • Accepted Date: 16 August 2025
  • First Published Date: 19 August 2025
  • Published Date: 01 December 2025

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