[1]李泽耀,刘昊媛,李梦滢.职工医保门诊共济政策对门诊患者医疗费用的影响研究[J].卫生经济研究,2026,43(05):63-66,70.
　LI Zeyao,LIU Haoyuan,LI Mengying.Impact of the Employee Medical Insurance Outpatient Mutual Aid Policy on Outpatient Medical Expenses[J].Journal Press of Health Economics Research,2026,43(05):63-66,70.
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职工医保门诊共济政策对门诊患者医疗费用的影响研究

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
43
期数:
2026年05期
页码:
63-66,70
栏目:
医疗保障
出版日期:
2026-04-24

文章信息/Info

Title:
Impact of the Employee Medical Insurance Outpatient Mutual Aid Policy on Outpatient Medical Expenses
作者:
李泽耀1; 2; 刘昊媛1; 2; 李梦滢1
1.北京清华长庚医院/清华大学临床医学院，北京 102218
2.清华大学医院管理研究院，北京 100084
Author(s):
LI Zeyao;  LIU Haoyuan;  LI Mengying
Beijing Tsinghua Changgung Hospital / School of Clinical Medicine, Tsinghua University, Beijing 102218, China
关键词:
职工医保; 门诊共济; 阻塞性睡眠呼吸暂停; 门诊费用
Keywords:
employee medical insurance;  outpatient mutual aid;  obstructive sleep apnea;  outpatient expenses
分类号:
F840.684
文献标志码:
A
摘要:
目的：分析职工医保门诊共济政策对阻塞性睡眠呼吸暂停（OSA）患者门诊费用的影响。方法：基于北京市某三级医院门诊患者数据，采用双重差分模型分析门诊共济政策对OSA患者门诊费用的影响，采用结构变动度分析门诊次均费用构成变化。结果：门诊共济政策实施后，OSA患者门诊总费用显著增长，化验检查费用为主要增长项，卫生材料费占比下降。结论：职工医保门诊共济政策提升了门诊服务可及性并释放了潜在医疗需求，但当前医疗服务价值补偿结构型失衡，应增强与医保支付方式改革的联动，实现慢病全周期管理和医保精细化监测。
Abstract:
Objective To analyze the impact of the employee medical insurance outpatient mutual aid policy on outpatient expenses of patients with obstructive sleep apnea(OSA). Methods Based on outpatient data from a tertiary hospital in Beijing, a difference-in-differences(DID) model was used to analyze the impact of the outpatient mutual aid policy on outpatient expenses of OSA patients, and structural variation analysis was applied to examine changes in the composition of average cost per visit. Results After the implementation of the outpatient mutual aid policy, the total outpatient expenses of OSA patients increased significantly. Laboratory and examination costs were the main drivers of the increase, while the proportion of sanitary material costs decreased. Conclusion The employee medical insurance outpatient mutual aid policy improves the accessibility of outpatient services and releases potential medical demand. However, structural imbalances in the value compensation of medical services persist. It is necessary to strengthen the linkage with medical insurance payment method reform to achieve full-cycle management of chronic diseases and refined medical insurance monitoring.

参考文献/References:

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更新日期/Last Update: 2026-04-24