SPEAKER: 王杉 中山大学管理学院副教授

TIME/DATE: 2025.9.22  10:00

CLASSROOM: A402

ABSTRACT

While Diagnosis-Related Group (DRG) payment schemes are widely adopted to incentivize cost reductions, many countries and regions persist in using Fee-for-Service (FFS) payment for outpatient services. This hybrid reimbursement system may prompt providers to make strategic responses on reducing treatment cost, shifting mild inpatients to outpatient care, and unbundling a portion of inpatient costs as outpatient expenses. To evaluate the behavioral incentives of this payment structure and the associated impacts, we first examine the regulator’s optimal solutions regarding cost reduction, care shifting, and cost unbundling aimed at maximizing social welfare. The analysis reveals that regulatory goals should be different according to providers’ outpatient care capabilities. Based on the yardstick competition framework, we then investigate providers’ equilibrium decisions. Our findings demonstrate that traditional yardstick competition fails to meet regulatory goals, as providers’ cost unbundling behavior diminishes their incentives to reduce costs and shift care. To facilitate regulatory goals and enhance social welfare, we further propose several possible approaches. First, for providers with low outpatient care capabilities, a coarser DRG grouping model is advisable, whereas a finer model is more suitable for high-capability providers. Second, stringent monitoring and regulation of cost unbundling practices are essential. Additionally, for high-capability providers, implementing yardstick competition for minor inpatient treatments yields significant efficiency and should be recommended.

GUEST BIO

王杉，现任中山大学管理学院副教授、逸仙优秀学者。2019年于上海交通大学安泰经济与管理学院获博士学位，研究方向聚焦于含复杂行为与约束的服务系统设计及优化，尤其关注医疗保健这一特殊应用领域，研究目标为实现医疗服务的及时、有效与高效供给。相关成果发表于Management Science、M&SOM等国内外权威期刊，获国家自然科学基金优秀青年科学基金项目资助，并荣获教育部高等学校科学研究优秀成果奖（人文社会科学）二等奖、POMS CHOM最佳论文奖等国内外学术奖项。目前担任Health Care Management Science副主编。