The Analysis of Provider Payment Reforms on Advancing China’s Health (APPROACH) project shifted the payment method of China’s rural health insurance scheme for county hospitals from fee-for-service to a novel global budget. APPROACH conducted a large-scale RCT of the global budget in 56 counties (22 million enrollees) of Guizhou province from 2016–2017. Applying randomization inference to claims data, we find a significant shift of inpatient utilization and expenditure from out-of-county hospitals to county hospitals. At county hospitals, average expenditure per admission and length of stay decreased, though not significantly. Effects on readmissions show no clear sign of compromised quality.
Zhang, Hao, Luying Zhang, Roman Xu, Jay Pan, Min Hu, Weiyan Jian, and Winnie Yip. 2022. “Can a Global Budget Improve Health Care Efficiency? Experimental Evidence from China.” Health Economics hec.4531. doi: 10.1002/hec.4531.