[1]张小娟,郝春彭.居民医保门诊保障水平对医疗服务利用和费用的影响[J].卫生经济研究,2022,39(11):23-26.
　ZHANG Xiaojuan,HAO Chunpeng.The Impact of Resident Health Insurance Outpatient Coverage Levels on Medical Service Utilization and Costs[J].Journal Press of Health Economics Research,2022,39(11):23-26.
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居民医保门诊保障水平对医疗服务利用和费用的影响
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
39
期数:
2022年11期
页码:
23-26
栏目:
医疗保障
出版日期:
2022-10-26

文章信息/Info

Title:
The Impact of Resident Health Insurance Outpatient Coverage Levels on Medical Service Utilization and Costs
作者:
张小娟1; 2; 郝春彭2
1.中国医学科学院医学信息研究所，北京 100020
2.中国医疗保险研究会，北京 100013
Author(s):
ZHANG Xiaojuan;  HAO Chunpeng
Institute of Medical information, Chinese Academy of Medical Sciences, Beijing 100020, China
关键词:
居民医保; 门诊保障; 服务利用; 医疗费用
Keywords:
resident health insurance;  outpatient coverage;  service utilization;  medical costs
分类号:
F840.684
文献标志码:
A
摘要:
目的：分析不同门诊保障水平对医疗服务利用和费用的影响。方法：基于基本医保参保人员医疗服务利用调查数据，构建Probit回归和多元线性回归模型。结果：实施门诊统筹但保障水平较低，不会增加门诊服务的利用，也不会减少住院服务的利用，只有当门诊保障水平较好时，门诊服务利用才会明显增加，并减少住院服务的利用。门诊保障较好的地区年住院费用相对更低，门诊保障一般的地区年住院费用反而更高；实施门诊统筹会提高年总费用。结论：调整医保待遇保障组合，提高门诊保障水平和医保基金支出效率。
Abstract:
Objective To analyze the effects of different levels of outpatient coverage on the utilization and costs of medical services. Methods Probit regression and multiple linear regression models were constructed based on medical service utilization survey data of basic medical insurance participants. Results The implementation of outpatient co-ordination showed a lower level of coverage, which would not increase the utilization of outpatient services or reduce the utilization of inpatient services. Only a sound level of outpatient coverage could increase the utilization of outpatient services and reduce the utilization of inpatient services. Annual inpatient costs were relatively lower in areas with better outpatient coverage, but higher in areas with average outpatient coverage. The implementation of outpatient coordination would increase total annual costs. Conclusion It is suggested to adjust the combination of health insurance treatment coverage to improve the level of outpatient coverage and the efficiency of health insurance fund expenditure.

参考文献/References:

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更新日期/Last Update: 2022-10-26