门诊共济背景下职工医保个人账户对卫生服务利用的影响——基于广东省三市的实证研究  

The influence of employees' medical insurance individual account on medical service utilization under the background of outpatient mutual aid:An empirical study based on three cities in Guangdong province,China

作　　者：张慧[1] 李雪竹 陈晓洁[2] ZHANG Hui;LI Xue-zhu;CHEN Xiao-jie(School of Public Health,Sun Yat-sen University,Guangzhou Guangdong 510080,China;The Eighth Affiliated Hospital,Sun Yat-Sen University,Shenzhen Guangdong 518000,China)

机构地区：[1]中山大学公共卫生学院,广东广州510080 [2]中山大学附属第八医院,广东深圳518000

出　　处：《中国卫生政策研究》2023年第7期1-9,共9页Chinese Journal of Health Policy

基　　金：国家自然科学基金项目(72274225,71704194);广东省基础与应用基础研究基金(2023A1515011725)。

摘　　要：目的:考察门诊共济背景下,职工医保个人账户对卫生服务利用的影响,并探究不同门诊统筹模式下二者的关系。方法:利用广州、深圳、肇庆职工医保参保人问卷调查数据,使用两部模型进行统计分析。结果:1 527名参保人个人账户余额均值为3 896.04元,门诊费用均值为585.63元,个人账户支出额均值为1 022.59元。总样本中,个人账户余额对门诊服务利用概率、门诊费用无影响;亚组中,肇庆市与门诊服务利用率相关,广州市与门诊费用呈正相关,深圳市与门诊服务利用无关。总样本中,个人账户余额对个人账户利用率无影响,但与个人账户支出额呈正相关;亚组中,三市与个人账户支出额均呈正相关。结论:门诊共济的背景下,个人账户余额对门诊服务利用无影响,但对个人账户利用产生影响。不同门诊统筹模式下,个人账户余额对卫生服务利用的影响存在差异。Objective:To analyze the influence of Employees' Medical Insurance Individual Account(EMIIA) on health service utilization of Urban Employees Basic Medical Insurance(UEBMI) under the background of outpatient mutual aid,and explore the association between EMIIA balance and health service utilization under different outpatient pooling aid models.Methods:Two models were employed for statistical analysis based on the questionnaire data of UEBMI participants in Guangzhou,Shenzhen and Zhaoqing City.Results:For 1527 UEBMI participants,the average balance of the personal account was 3896.04 Yuan;the average outpatient expenses were 585.63 Yuan;and the average EMIIA expenditure was 1022.59 Yuan.In the overall sample,EMIIA balance had no effect on the probability of outpatient service utilization and outpatient expenses.In the subgroup,EMIIA balance in Zhaoqing City was positively associated with the probability of outpatient service utilization;EMIIA balance was positively associated with outpatient expenses in Guangzhou;EMIIA balance had nothing to do with outpatient service utilization in Shenzhen.In the overall sample,the balance of the individual account had no significant effect on the probability of individual account utilization,while EMIIA balance was positively associated with EMIIA expenses.In the subgroup,there was a positive association between the EMIIA balance and EMIIA expenses in three cities.Conclusions:Under the outpatient pooling aid policy,individual accounts have no effect on the utilization of outpatient services,but have an effect on the utilization of individual accounts.The impact of individual accounts on utilization of health services was different under different outpatient pooling aid modes.

关 键 词：门诊共济保障 个人账户 卫生服务利用 门诊服务利用 个人账户利用 

分 类 号：R197[医药卫生—卫生事业管理]