总额预付和增加基层医疗资源对分级诊疗的影响——基于CHARLS数据的实证分析

我国在建立分级诊疗制度过程中,分别通过对医疗资源需求端制定差异化报销比例,对供给端进行资源结构性调整,以引导患者向基层流动就诊,实现医疗资源更高效利用,缓解看病难、看病贵的社会问题。本文采用2013年"中国健康与养老追踪调查"(CHARLS)数据,运用Logit回归模型,分析预付制及增加基层医疗资源是否促进了患者到基层接受门诊治疗。实证研究发现:总额预付以及增加基层医疗卫生机构医师资源对分级诊疗的促进作用显著;但单纯增加人均基层医疗卫生机构数量对患者到基层就诊没有明显吸引力。后续政策可考虑进一步完善总额预付制度、促进基层医疗资源质量的提高,并引导患者转变就医观念,以实现分级诊疗效果,调节医疗资源供给与需求不均衡的矛盾。

An empirical analysis of the effect of global budget and efforts to increase local community healthcare resource on tiered healthcare system: Based on the CHARLS

Different compensated rates for health care resources requirements and supply distribution adjustment have been applied under tiered health care system which guides the patients flow to primary health care institutions to use healthcare resources more efficiently. The main purpose is to address the social problems of expensive and hard-to-visit a doctor. This paper runs a Logit regression model to analyze the prepaid system in the global budget and examine whether efforts to increase primary health care resource have led patients to receive local treatment at the primary level based on CHARLS Data of 2013. Empirical findings show that applying global budget policy of increasing total amount and local physicians per primary medical institutions significantly increase the attendance probability while simply increasing the number of per capita primary medical institutions has no apparent effects. This paper suggests the follow-up policies to balance the health care resources requirement and supply in order to further improve the total prepaid system in the global budget policy and improve the primary health care resource quality, and guide the medical treatment for patients with changing rules. This will also help in achieving the balanced tiered health care system.