What does this research mean for the field?

The introduction of a blended diagnosis-based payment scheme with a global budget causes hospitals to engage in upcoding and admission shifting, widening payment disparities that favor larger, higher-tier hospitals with greater coding knowledge. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Investigate hospital strategic responses to a blended payment scheme combining diagnosis-based reimbursement with a global budget and assess its distributional consequences.

September 5, 2026International Economic ReviewOpen Access

Hospital Heterogeneous Responses to a Blended Payment Scheme Reform and the Distributional Consequences

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Authors

WYWei Yan HYHanmo Yang JYJunjian Yi

Discussion

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Overview

Quasi-experimental study reveals hospital upcoding and volume surges under blended payment schemes, indicating widening disparities in public health insurance distribution.

Key Points

Investigate hospital strategic responses to a blended payment scheme combining diagnosis-based reimbursement with a global budget and assess its distributional consequences.
Evaluated hospital behavior using a quasi-experimental payment reform in China.
Analyzed hospital-level responses including diagnostic upcoding, patient admission volume, and coding composition across hospital tiers and sizes.
Hospitals responded to the payment reform by engaging in diagnostic upcoding, increasing total patient admissions, and shifting admissions toward categories with higher upcoding potential.
Disparities in insurance fund distribution widened because larger, higher-tier hospitals with superior coding knowledge captured disproportionately larger shares of the social health insurance fund.

Cite This Study

Yan et al. (2026) studied this question.

synapsesocial.com/papers/6a9bd4346b95aff0620ebb86 https://doi.org/10.1111/iere.70106

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September 5, 2026International Economic ReviewOpen Access

Hospital Heterogeneous Responses to a Blended Payment Scheme Reform and the Distributional Consequences

View Full Paper

Ask AI

Bookmark

Authors

WYWei Yan HYHanmo Yang JYJunjian Yi

Discussion

Member takes

Overview

Quasi-experimental study reveals hospital upcoding and volume surges under blended payment schemes, indicating widening disparities in public health insurance distribution.

Key Points

Investigate hospital strategic responses to a blended payment scheme combining diagnosis-based reimbursement with a global budget and assess its distributional consequences.
Evaluated hospital behavior using a quasi-experimental payment reform in China.
Analyzed hospital-level responses including diagnostic upcoding, patient admission volume, and coding composition across hospital tiers and sizes.
Hospitals responded to the payment reform by engaging in diagnostic upcoding, increasing total patient admissions, and shifting admissions toward categories with higher upcoding potential.
Disparities in insurance fund distribution widened because larger, higher-tier hospitals with superior coding knowledge captured disproportionately larger shares of the social health insurance fund.

Cite This Study

Yan et al. (2026) studied this question.

synapsesocial.com/papers/6a9bd4346b95aff0620ebb86 https://doi.org/10.1111/iere.70106

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