The effect of hierarchical medical treatment reform——research based on 205 prefecture-level cities

The problems, such as difficult and expensive medical treatment, high medical costs, and low efficiency in utilizing medical resources, have been prominent for a long time. The state has taken a series of measures to solve these problems, and hierarchical medical treatment reform is one of the critical measures. This paper uses a staggered DID to empirically analyse the effect of hierarchical medical treatment in 205 prefecture-level cities. The results show that hierarchical medical treatment significantly shortens the hospital day but has no significant impact on visit ratio to primary medical institutions, and average outpatient and inpatient costs in hospitals. The reduction in the hospital stay is smaller in areas with higher vertical fiscal imbalance and fewer medical resources. The important reason for the failure of hierarchical medical treatment to achieve orderly treatment is that, it didn’t effectively improve the resources ratio in primary medical institutions. And the most fundamental reason lies in the incentive of the fiscal decentralization system. Therefore, this necessitates a more targeted approach in the reform to achieve the intended orderly treatment process.