我国患者公立和民营医疗机构就医选择对医疗费用的影响  

Impact of Patients'Choice of Medical Treatment Between Public and Private Medical Institutions on Medical Expense in China

作　　者：苏敏[1] 郭喜 李东旭 SU Min(School of Public Management,Inner Mongolia University,Hohhot,Inner Mongolia,010070,China)

机构地区：[1]内蒙古大学公共管理学院,内蒙古呼和浩特010070 [2]内蒙古工业大学经济管理学院,内蒙古呼和浩特010000 [3]济宁医学院公共卫生学院,山东济宁272067

出　　处：《医学与社会》2025年第4期60-65,88,共7页Medicine and Society

基　　金：国家自然科学基金资助项目,编号为72164031、72204128、71864025。

摘　　要：目的:分析我国患者在公立和民营医疗机构之间的就医选择对医疗费用的影响,以期为减轻患者医疗负担提供参考依据。方法:基于2011-2018年中国健康与养老追踪调查构成的面板数据,使用准自然实验法,追踪患者就医选择,采用OLS回归模型分析患者公立和民营医疗机构的就医选择对医疗费用的影响。结果:与民营医疗机构相比,患者在公立医疗机构就医的总费用(β=0.457,P<0.01)、自付总费用(β=0.276,P<0.01)、总药费(β=0.259,P<0.05)较高,总费用自付比(β=-0.105,P<0.01)、总药费自付比(β=-0.068,P<0.01)、药费占比(β=-0.090,P<0.01)较低。结论:患者在公立医疗机构就医的总费用、自付总费用和总药费高于民营医疗机构,总费用自付比、总药费自付比和药费占比低于民营医疗机构。通过加大财政补偿力度,完善医疗卫生价格体系和监督体系,平衡医生的自利性和公益性,能有效控制医疗费用和减轻患者医疗负担。Objective:To analyze the impact of patients'choices between public and private medical institutions on the medical expense,so as to provide reference basis for reducing patients'medical burden.Methods:Using panel data from the 2011-2018 China health and retirement longitudinal survey,the quasi-natural experiment method was used to track individual healthcare choices,and an OLS regression model was used to analyze the impact of patients'medical choice in public and private medical institutions on medical expenses.Results:It was found that compared with private medical institutions,patients visited public medical institutions with higher total cost(β=0.457,P<0.01),total out-of-pocket cost(β=0.276,P<0.01),and total drug cost(β=0.259,P<0.05),and the out-of-pocket ratio of total cost(β=-0.105,P<0.01),total out-of-pocket drug costs(β=-0.068,P<0.01),and percentage of drug costs(β=-0.090,P<0.01)were lower.Conclusion:The total cost,total out-of-pocket cost,and total drug cost of patients in public medical institutions are higher than those of private medical institutions,and the out-of-pocket ratio of total cost,total out-of-pocket drug costs,and percentage of drug costs are lower than those of private medical institutions.It is recommended to improve the financial compensation,improve the medical and health price system and supervision system,balance the self-interest and public welfare of doctors,and effectively control medical expenses and reduce the medical burden of patients.

关 键 词：就医选择 医疗费用 患者 公立医疗机构 民营医疗机构 

分 类 号：R-05[医药卫生] R197