[1]王佳怡,马骋宇,陈蒙恩,等.个人支付金额和就医频次对门诊慢特病患者就医流向的影响[J].卫生经济研究,2026,43(10):55-59.
　WANG Jiayi,MA Chengyu,CHEN Meng'en,et al.Impact of Out-of-Pocket Payment Amount and Visit Frequency on Healthcare-Seeking Flow of Outpatients with Chronic and Special Diseases[J].Journal Press of Health Economics Research,2026,43(10):55-59.
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个人支付金额和就医频次对门诊慢特病患者就医流向的影响

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年10期
页码:
55-59
栏目:
医疗保障
出版日期:
2026-10-01

文章信息/Info

Title:
Impact of Out-of-Pocket Payment Amount and Visit Frequency on Healthcare-Seeking Flow of Outpatients with Chronic and Special Diseases
作者:
王佳怡1; 马骋宇1; 陈蒙恩2; 杨敬宇3; 张 勰3
1.首都医科大学公共卫生学院，北京 100069
2.北京中医药大学中医/管理学院，北京 102400
3.甘肃中医药大学卫生管理学院，甘肃 兰州 730000
Author(s):
WANG Jiayi;  MA Chengyu;  CHEN Meng'en;  YANG Jingyu;  ZHANG Xie
School of Public Health, Capital Medical University, Beijing 100069, China
关键词:
个人支付金额; 就医频次; 就医流向; 门诊慢特病; Ologit模型
Keywords:
out-of-pocket payment amount;  visit frequency;  healthcare-seeking flow;  outpatient chronic and special diseases;  Ologit model
分类号:
R19
文献标志码:
A
摘要:
目的：分析个人支付金额和就医频次对门诊慢特病患者就医流向的影响，为深化门诊医保改革、推动分级诊疗落地提供实证参考。方法：基于2020—2024年兰州市职工医保门诊慢特病患者结算数据，采用Ologit模型进行分析。结果：2020—2024年，兰州市职工医保门诊慢特病患者选择三级、二级、无等级及一级医疗机构就诊的比例分别为76.44%、12.55%、11.01%；个人支付金额越高的患者，越倾向于选择低等级医疗机构；就医频次越高的患者，越倾向于选择高等级医疗机构；个人支付金额与就医频次交互作用对患者就医流向的影响具有异质性。结论：当前门诊慢特病患者仍高度集中在三级医疗机构；患者的就医决策是成本约束与医疗需求共同作用的结果，中高支付金额、中高就医频次的患者兼具价格敏感性和就医选择可调整性，是分级诊疗政策的核心干预对象，也是减轻三级医疗机构就诊压力的关键群体；未来应强化二级及基层医疗机构在慢特病管理中的承接功能，针对不同患者群体实施分层引导与精准干预策略，推动分级诊疗政策落地。
Abstract:
Objective To analyze the impact of out-of-pocket payment amount and visit frequency on the healthcare-seeking flow of outpatients with chronic and special diseases. Methods Based on settlement data of outpatients with chronic and special diseases under the employee medical insurance program in Lanzhou City from 2020 to 2024, an Ologit model was used for analysis. Results From 2020 to 2024, the proportions of outpatients with chronic and special diseases in Lanzhou City choosing tertiary, secondary, unclassified, and primary medical institutions were 76.44%, 12.55%, and 11.01%, respectively. Patients with higher out-of-pocket payment amounts were more inclined to choose lower-level medical institutions; patients with higher visit frequencies were more inclined to choose higher-level medical institutions. The interaction between out-of-pocket payment amount and visit frequency had a heterogeneous impact on patients' healthcare-seeking flow. Conclusion Currently, outpatients with chronic and special diseases remain highly concentrated in tertiary medical institutions. Patients' healthcare-seeking decisions result from the combined effect of cost constraints and medical needs. Patients with moderate-to-high payment amounts and moderate-to-high visit frequencies possess both price sensitivity and adjustability in healthcare-seeking choices, making them the core intervention target for hierarchical diagnosis and treatment policies and the key group for reducing the pressure on tertiary medical institutions. In the future, it is necessary to strengthen the receiving function of secondary and primary medical institutions in the management of chronic and special diseases, implement stratified guidance and precise intervention strategies for different patient groups, and promote the implementation of hierarchical diagnosis and treatment policies.

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更新日期/Last Update: 2026-10-08