异地就医直接结算对中老年人医疗经济负担的影响研究——基于职工补充医保的中介效应分析  

Study on the Influence of Direct Settlement for Transprovincial Medical Treatment on the Economic Burden of the Middle-aged and Elderly——An Analysis of Intermediary Effect Based on Supplementary Medical Insurance for Employees

作　　者：吴汉辉 张晓香 

机构地区：[1]华中农业大学经济管理学院,武汉430070 [2]湖北中医药大学管理学院,武汉430065

出　　处：《中国医疗保险》2023年第5期55-63,共9页China Health Insurance

基　　金：湖北省社科基金一般项目“异地就医直接结算与我国医疗服务利用公平性研究——基于A市的实证”(2019115)。

摘　　要：目的:分析异地就医直接结算对中老年人医疗经济负担的影响,为缓解我国中老年人“看病难、看病贵”问题提出建议。方法:基于我国A县级市2020年—2021年某医院中老年职工医疗保险住院报销数据,运用处理效应模型和中介效应模型进行研究。结果:(1)异地就医直接结算在一定程度上缓解了中老年人“看病贵”难题;(2)异地就医直接结算政策的实施提高了中老年参保人获得医疗资源的可及性以及医疗保险待遇水平;(3)职工补充医保在异地就医直接结算减轻中老年人医疗经济负担过程中存在显著的中介效应,占总效应的比重为34.4%。结论:政府应贯彻落实异地就医直接结算政策,进一步发挥职工补充医保对重疾转诊患者医疗费用的报销补偿作用,并通过医联体建设、基层全科医生培养做实分级诊疗制度。Objective:The paper attempts to alleviate the problem of "difficult and expensive medical treatment" for the middle-aged and elderly in China by analyzing the influence of direct settlement for transprovincial healthcare on the medical economic burden of the middle-aged and elderly.Methods:Based on the hospitalization reimbursement data of medical insurance for middle-aged and elderly employees in a certain hospital in city A of China from 2020 to 2021,the treatment effect model and intermediary effect model is used in this study.Results:The immediate reimbursement for transprovincial healthcare alleviates the economic burden of the middle-aged and elderly to a certain extent.The implementation of immediate reimbursement for transprovincial healthcare has improved the accessibility of medical resources and medical insurance for the middle-aged and elderly participants of basic medical insurance.Supplementary medical insurance for employees plays a significant intermediary role in the process of immediate reimbursement alleviating the burden of the middle-aged and elderly people,and the intermediary effect accounts for 34.4%.Conclusion:The government should implement the medical insurance policy of immediate reimbursement and further play the role of supplementary medical insurance for employees in the medical expenses of transferred patients with serious illness,carry out grading diagnosis and treatment through the construction of medical union and grass-roots general practitioners.

关 键 词：基本医疗保险 职工补充医保 异地就医直接结算 老龄化 医疗经济负担 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]