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題名 Top-up design and health care expenditure: Evidence from cardiac stents
作者 連賢明
Jin, Ginger Zhe;Lien, Hsienming;Tao, Xuezhen
貢獻者 財政系
關鍵詞 Top-up design; Health care cost; Cardiac stent; Moral hazard
日期 2025-10
上傳時間 30-Jan-2026 11:06:37 (UTC+8)
摘要 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 price difference for more expensive treatment (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. In contrast with hospitals with no previous revenue from stent treatment, hospitals that were more revenue-dependent on cardiac patients reduced the likelihood of stent implantation by 21.2%, increased BMS usage per stent patient by 0.10 or 11.9% but not DES usage. Furthermore, while the average DES price remains insensitive to the rate cut across the whole sample, minor teaching hospitals previously more dependent on stent patients increased the DES price and therefore could recoup at least half of the revenue loss from the NHI rate cut in 2009-2010. In general, the rate cut was effective in reducing NHI expenditure without substantial changes in patient outcomes, although some minor teaching hospitals made moral hazard adjustments in response.
關聯 China Economic Review, Vol.93, 102489
資料類型 article
DOI https://doi.org/10.1016/j.chieco.2025.102489
dc.contributor 財政系
dc.creator (作者) 連賢明
dc.creator (作者) Jin, Ginger Zhe;Lien, Hsienming;Tao, Xuezhen
dc.date (日期) 2025-10
dc.date.accessioned 30-Jan-2026 11:06:37 (UTC+8)-
dc.date.available 30-Jan-2026 11:06:37 (UTC+8)-
dc.date.issued (上傳時間) 30-Jan-2026 11:06:37 (UTC+8)-
dc.identifier.uri (URI) https://ah.lib.nccu.edu.tw/item?item_id=180851-
dc.description.abstract (摘要) 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 price difference for more expensive treatment (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. In contrast with hospitals with no previous revenue from stent treatment, hospitals that were more revenue-dependent on cardiac patients reduced the likelihood of stent implantation by 21.2%, increased BMS usage per stent patient by 0.10 or 11.9% but not DES usage. Furthermore, while the average DES price remains insensitive to the rate cut across the whole sample, minor teaching hospitals previously more dependent on stent patients increased the DES price and therefore could recoup at least half of the revenue loss from the NHI rate cut in 2009-2010. In general, the rate cut was effective in reducing NHI expenditure without substantial changes in patient outcomes, although some minor teaching hospitals made moral hazard adjustments in response.
dc.format.extent 108 bytes-
dc.format.mimetype text/html-
dc.relation (關聯) China Economic Review, Vol.93, 102489
dc.subject (關鍵詞) Top-up design; Health care cost; Cardiac stent; Moral hazard
dc.title (題名) Top-up design and health care expenditure: Evidence from cardiac stents
dc.type (資料類型) article
dc.identifier.doi (DOI) 10.1016/j.chieco.2025.102489
dc.doi.uri (DOI) https://doi.org/10.1016/j.chieco.2025.102489