医保差异化补偿政策下北京居民就医流向的影响因素研究

目的：分析医保差异化报销政策下北京市居民就医流向的影响因素，为促进与完善分级诊疗制度提供理论依据和政策参考。方法：自行设计调查问卷对北京市550位参保人进行随机抽样调查，采用单因素分析和二元Logistic回归模型，探究差异化医保报销下居民就医选择偏好及影响因素。结果：若参保人因常见病或多发病就医，门诊或者住院实施差异化医保报销政策时，分别有63.82%和59.09%的参保人认为该政策会影响其门诊或住院行为。家庭人均可支配收入、基层服务能力对居民在差异化医保报销政策下的就医选择行为有显著作用（P<0.05）。结论：差异化医保补偿方式对居民基层就诊和住院有一定引导作用，但鉴于目前医保报销比例差距不明显，且易受个体经济状况、倾向特征和不同等级医疗机构服务质量异质性的影响，该政策不足以引导居民合理就医。

The influencing factors of residents' medical treatment flow under differentiated reimbursement policy of medical insurance

Objective:To analyze the influencing factors of differentiated reimbursement policy on the medical treatment flow of Beijing residents and provide theoretical basis and policy reference for promoting and improving the hierarchical medical system. Methods:A self-designed questionnaire was used to carry out a random sampling survey among 550 insured people residing in Beijing. The Univariate of Single-factor analysis and binary Logistic regression model were used to explore residents'' preference of medical treatment and its influencing factors under differentiated medical insurance reimbursement. Results:When differentiated medical insurance reimbursement policies were implemented for outpatient or inpatient services due to common or frequently-occurring diseases, 63.82% and 59.09% of the insured persons believed that such policies would affect their outpatient or inpatient behaviors, respectively. The household per capita disposable income and service capacity of primary healthcare institutions had a significant effect on residents'' behavioral choice of medical treatment under differentiated medical insurance reimbursement policies (P<0.05). Conclusions:Differentiated medical insurance compensation methods have a certain guiding effect on the treatment and hospitalization of residents at the grassroots level. However, given the current reimbursement proportion disparity which is not obvious and easily affected by individual economic status, tendency characteristics and the heterogeneity of service quality of different levels of healthcare institutions, the policy is not enough to guide the residents to seek medical treatment reasonably.