跨省异地结算政策对患者就医选择及费用负担的影响——基于北京某肿瘤医院的实证分析

目的:分析跨省异地结算政策对北京大学肿瘤医院住院患者的服务量影响,研究政策对外地患者产生的费用负担差异,评估政策效果,为政策完善提供实证证据。方法:回顾性资料分析,以2017年3月为政策干预起始月,利用间断时间序列回归分析2016年1月—2018年3月间异地政策对住院服务量的变动影响;利用倾向性评分匹配性别、年龄、科室属性、诊断个数及其诊断类别等指标后,评估异地政策对外地患者费用负担的差异影响。结果:改革前后外地人群占比变动了1.70%,但改革的即刻变化和趋势变化的统计学差异都没有显著性,改革当月外地人群出院量当即上涨378.22人次(P>0.1),改革后趋势为每月上涨28.08人次(P>0.1);异地结算之后,实时报销的外地患者比手工报销患者的住院次均费用平均上涨了402.70~726.81元(P>0.1),药占比高出6.47%(P<0.01)。结论:异地结算政策没有显著刺激肿瘤人群跨区域就医和增加患者的直接医疗负担,就医地目录政策可能会使得更多的患者流向宽目录省市。

Analysis on the effect of trans-provincial offset medical settlement policy on medical behavior and cost burden: An empirical analysis based on a cancer hospital in Beijing

Objectives:To analyze the effect of trans-provincial offset medical settlement policy on the service volume of inpatients in Peking University Cancer Hospital; to study the differences in the cost burden faced by the trans-provincial patients; and provide empirical evidence for the policy improvement. Methods:This article used the retrospective data analysis method taking March 2017 as the starting month of policy intervention and intermittent time series regression to analyze the policy impact on the inpatient volume during the period from January 2016 to March 2018. The propensity scores method was used to match the gender, age, departmental attributes, number of diagnoses, and the diagnostic categories of inpatients. Thereinafter, the differences in the cost burden were evaluated. Results:The proportion of trans-provincial patient changed by 1.70% before and after the policy; but the statistical changes were not significant, with the reform month immediately yielding an increase of 387.22 (P>0.1) and post-reform monthly upgrade of 28.08 (P>0.1). After the policy, the average treatment effect of hospitalization cost on the offset medical settlement varied in a range of 402.70~726.81 Yuan (P>0.1), while the percentage of the same effect produced by drug proportion was 6.47% (P<0.01). Conclusions:The offset medical settlement policy neither significantly stimulates people to seek medical treatment across the region, nor does increase the direct medical treatment and healthcare burden experienced by cancer patients. The wider range of medical insurance catalog is more likely to lead patient to making different choices based on the availability and cost-effectiveness of the cancer treatment means.