Abstract
BACKGROUND AND OBJECTIVES: Recently, the financial burden on medical insurance funds has increased rapidly. The policy effects of paying for innovation await scientific measurement. This study uses DBS, a high-value medical product, as an example to quantify the causal effect of insurance coverage changes on healthcare utilization, informing global value-based payment strategies. METHODS: We identified 2,665 DBS-related records. After excluding cases with missing data, no implantation, diagnoses for comorbidity management or device adjustment, pre-surgery admissions, and abnormal length of stay, 2,471 cases were included for analysis. A nonparametric sharp regression discontinuity design was adopted to assess the causal effects of reimbursement strategy adjustments on eight measures of healthcare utilization. In addition, we performed robustness analyses. RESULTS: The reimbursement strategy adjustment significantly reduced the individual out-of-pocket expenditure (β=-109,051.30, P < 0.001), increased medical insurance reimbursement cost (β = 128,347.14, P < 0.001), and shortened both the average length of recovery (β=-28.23, P < 0.01)and the average length of stay (β=-37.41, P < 0.001). After accounting for covariates, the results remained significant, though the effect estimates were all attenuated, suggesting a strong association between demographic and medical characteristics and healthcare utilization. Additionally, the effects on total surgical cost, surgical consumable cost and proportion of drug costs were not statistically significant at the 0.05 level. CONCLUSION: The medical insurance reimbursement strategy adjustment effectively reduces patients' economic burden and improves healthcare utilization. However, it is crucial to consider strengthening cost monitoring for high-value medical technologies, optimizing clinical pathways, and balancing the interests of patients, hospitals, and insurance funds.