政策促进还是政策摩擦?——医疗保险异地结算与分级诊疗的政策交互作用研究  

Policy Promotion or Policy Friction?——Research on Policy Interaction between Medical Insurance Immediate Settlement,and Hierarchical Diagnosis and Treatment

作　　者：钟玉英[1] 王凯然 梁婷 Yuying Zhong;Kairan Wang;Ting Liang

机构地区：[1]华南理工大学公共管理学院 [2]华南理工大学

出　　处：《公共行政评论》2020年第5期120-143,207,208,共26页Journal of Public Administration

基　　金：广东省哲学社会科学“十三五”规划项目2019年度课题“政策交互效应视角下粤港澳大湾区异地就医制度优化研究”(GD19CZZ01);广州市哲学社会科学“十三五”规划2018年度课题(2018GZYB15);华南理工大学中央高校基本科研业务费专项资金资助(2015GD03)。

摘　　要：【问题】多项医疗公共政策之间可能存在相互作用,研究这种交互作用对完善公共政策相互作用理论、推进后续医改政策设计有重要意义。近年来医保异地联网结算与分级诊疗制度齐头并进,这两种政策间到底产生了政策促进还是政策摩擦?【方法】论文利用广东省A市B区城乡居民医保结算数据,有效样本达23万,对城乡居民前往异地三级医院住院就医人次和费用作卡方检验和方差分析,并运用PSM-DID模型分析政策间的影响。【发现】医保异地联网结算政策对分级诊疗制度产生了政策摩擦,即异地联网结算政策的实施推高了异地三级医院的就医人次,增加了患者前往异地三级医院的住院支出总额与个人支付费用。但异地联网结算政策对城乡居民医保基金的支付负担没有显著影响,且对总体上提升异地就医者的健康公平具有政策促进作用。【贡献】论文从公共政策相互作用理论视角,用PSM-DID等方法分析医疗卫生领域两项政策的相互作用,弥补了现有研究较少基于医保结算数据量化分析政策间相互作用的不足,为公共政策相互作用理论提供了医疗卫生政策领域的实证证据及改进建议;更为异地联网结算政策和分级诊疗制度的各自完善和相互协同提供了实证依据。Motivation:Many public health policies interact with each other.Studying these interactions helps theorizing about public policy interactions and promotes the design of follow-up health reform policy.In recent years,the Immediate Settlement Policy and Hierarchical Diagnosis and Treatment policies have gone hand in hand.Is there a promotion or a friction effect between them?Methodology:This paper presents an analysis of the medical insurance settlement data of Urban and Rural Residents in B district of A city in Guangdong.The effective sample is 230,000 settlement.Tests include chi-square test and variance analysis on the inpatient visits and expenses of insured patients to distant tertiary hospitals.The PSM-DID model analyzes the impact of Immediate Settlement Policy on the implementation effect of Hierarchical Diagnosis and Treatment.Findings:“Policy friction”exists between the Immediate Settlement Policy and Hierarchical Diagnosis and Treatment.The implementation of the policy of settlement of long-distance network to some extent pushes up the number of visits to target tertiary hospitals outside a patient's home city and increases the total hospitalization expenditures and the payments of patients.However,the Immediate Settlement Policy has no significant impact on the payment burden of Urban and Rural Residents'Medical Insurance Funds,and has a policy-promoting effect on improving the health equity of off-site medical patients in general.Contribution:From the perspective of public policy interaction theory,this paper analyzes the interaction between two policies in the field of health care using PSM-DID and other methods.This makes up for the lack of interaction analysis between policies based on the quantitative analysis of medical insurance settlement data.This paper also provides empirical evidence and suggestions from the field of health policy for the improvement of public policy interaction theory.It offers an empirical basis for the respective renovation of Immediate Settlement Policies,Hierarchica

关 键 词：异地就医 异地联网结算 分级诊疗 政策促进 政策摩擦 

分 类 号：D63[政治法律—政治学]