湖北省新健康扶贫政策实施效果分析——以咸宁市4县为例

目的：探究湖北省新健康扶贫政策的实施影响，为“十四五”时期调整医疗救助制度提供科学依据和政策建议。方法：使用咸宁市所有4个县2018年7月—2020年9月月度建档立卡农村贫困人口（简称“农村贫困人口”）住院报销数据，应用间断时间序列分析方法，从救助支出、就医行为和救助效果三个维度分析医疗救助制度运行情况的变化。结果：政策实施后，医疗救助总支出显著减少；农村贫困人口在三级、二级医疗机构就诊人次占比显著减小，在一级及以下医疗机构、县域内医疗机构、县域内医疗机构或指定转诊医疗机构就诊人次占比显著增加；农村贫困人口人均实际负担费用显著减少，灾难性医疗卫生支出发生人数占比显著下降。结论：新健康扶贫“985”政策节省了救助支出，规范了农村贫困人口就医行为，改善了救助效果。下一步应科学设定医疗救助标准、适度拓展救助对象，同时规范救助管理体制，提高县域内基层医疗卫生服务水平，进一步优化医疗救助制度。

Analysis of the implementation effectiveness of the new health and medical assistance policy for poverty alleviation in Hubei Province: Evidence from four counties in Xianning City

Objectives:To evaluate the social influence of the new health and medical assistance policy for poverty alleviation in Hubei Province, so as to provide scientific references and policy suggestions for adjusting the medical assistance system during the 14^th Five-Year Plan. Methods:Monthly hospital services reimbursement data of registered rural poor individuals from all four counties of Xianning from July 2018 to September 2020 were collected. Interrupted Time Series (ITS) analysis was adopted to analyze the changes in the operation status of the medical assistance system from three different dimensions:healthcare expenditure, patients'' behavior in seeking healthcare, and healthcare effectiveness. Results:Following the implementation of the policy, the overall expenditure for medical assistance significantly decreased, and the proportion of rural poor individuals seeking healthcare services in tertiary and secondary healthcare facilities also significantly decreased. However, the proportion of healthcare assistance recipients in primary healthcare facilities or below, in county healthcare facilities or in designated referral healthcare facilities significantly increased. On the other hand, patients'' out-of-pocket expense per capita significantly decreased, and the proportion of patients incurring catastrophic healthcare expenditures also significantly decreased. Conclusions:The implementation of the new health and medical assistance policy for poverty alleviation successfully reduced the medical assistance expenditure, standardized the rural poor individuals'' behavior in seeking healthcare, and improved the effectiveness of the medical assistance system. It is suggested that in the future the standards of medical assistance should be set scientifically, the recipient population of medical assistance should be appropriately expanded, and in the meanwhile the medical assistance management system should be standardized, so as to further improve the quality of the county''s basic healthcare services and optimize the medical assistance system.