推行分级诊疗制度对医疗费用影响研究——以全国270个城市大规模分级诊疗试点为自然实验的分析  

Study on the Impact of Implementing a Tiered Diagnosis and Treatment System on Medical Expenses——Analysis based on a natural experiment of large-scale tiered diagnosis and treatment pilots in 270 cities nationwide

作　　者：李成[1] 马桑[1] 陈茜 LI Cheng;MA Sang;CHEN Qian

机构地区：[1]云南大学政府管理学院 [2]广西医科大学人文社会科学学院

出　　处：《价格理论与实践》2024年第12期109-114,共6页Price:Theory & Practice

基　　金：广西高校人文社会科学重点研究基地(健康与经济社会发展研究中心)项目“新医改背景下广西分级诊疗政策效果研究”(2021RWB20);云南大学研究生科研基金创新项目“保障公平视角下我国农村居民养老保险财政补贴政策研究”(KC-23233979)

摘　　要：自新医改以来,国家致力于加强基层卫生服务体系建设,着力提高基层医疗卫生机构服务水平和质量,逐步建立分级诊疗和双向转诊制度。基于此,本文在总结分级诊疗政策对医疗费用影响机制的基础上,使用中国健康与养老追踪调查(CHARLS)数据,以全国大规模分级诊疗试点为自然实验,采用双重差分法进行实证分析,探讨分级诊疗推行对居民医疗费用的影响。研究结果表明:第一,分级诊疗政策通过医疗资源层级优化效应、医疗费用梯度分担效应以及医疗行为规范化成本效应降低居民住院费用。第二,实施分级诊疗政策让试点城市中老年居民比未实施该政策的其他城市中老年居民的年均住院费用和年均住院自付费用明显降低,该研究结论在考虑稳健性检验后依然成立。鉴于此,应通过深化基层就医报销比例优化机制、构建协同高效的分级诊疗服务体系等方式,提高分级诊疗的实施效果。Since the new healthcare reform,China has been committed to strengthening the construction of the primary healthcare service system,focusing on improving the service level and quality of primary healthcare institutions,and gradually establishing a tiered diagnosis and treatment system as well as a two-way referral system.Based on this background,this paper summarizes the impact mechanism of the tiered diagnosis and treatment policy on medical expenses.Using data from the China Health and Retirement Longitudinal Study(CHARLS),this paper empirically analyzes the impact of implementing a tiered diagnosis and treatment system on residents’medical expenses through a natural experiment of large-scale tiered diagnosis and treatment pilots nationwide,employing the Difference-in-Differences(DID)method.The research findings indicate:Firstly,the tiered diagnosis and treatment policy reduces residents’hospitalization expenses through the hierarchical optimization effect of medical resources,the gradient cost-sharing effect of medical expenses,and the cost effect of standardized medical behavior.Secondly,the implementation of the tiered diagnosis and treatment policy significantly reduces the average annual hospitalization expenses and out-of-pocket hospitalization expenses for middle-aged and elderly residents in pilot cities compared to those in other cities where the policy has not been implemented.These conclusions remain valid after considering robustness checks.In light of this,the effectiveness of implementing the tiered diagnosis and treatment system should be enhanced by deepening the optimization mechanism for reimbursement ratios at primary healthcare institutions and constructing a coordinated and efficient tiered diagnosis and treatment service system.

关 键 词：分级诊疗 居民医疗费用 双重差分 

分 类 号：R197.1[医药卫生—卫生事业管理]