本文基于CMDS数据库2018年的数据,应用倾向得分匹配（PSM）研究跨省异地就医住院费用直接结算对住院费用的影响。研究发现,跨省异地就医住院费用直接结算政策的实施对住院总费用未产生显著影响,对住院自付费用的影响并不稳定,对住院报销费用产生了显著影响。回归系数显示,实施跨省异地就医住院费用直接结算政策后,样本个体人均住院报销费用提高了4009.45元,该政策的实施对住院报销费用有显著正向处理效应。通过替换被解释变量进行稳健性检验后,上述结论依然成立。基于研究结论,本文提出以下建议：提高异地就医结算体系的响应度和稳定性,高质量推进跨省异地就医住院费用直接结算;合理引导患者选择异地就医去向,提高医疗资源整体使用率。

Based on the 2018 data in the CMDS database, propensity score matching (PSM) was applied to study the impact of direct settlement for transprovincial inpatient medical expenses beyond the pooling district on inpatient medical expenditures. The study found that the implementation of the direct settlement for transprovincial inpatient medical expenses policy had no significant impact on the total inpatient expenses, and the impact on outof-pocket inpatient expenses was not stable, but it had a significant impact on inpatient reimbursement expenses. The regression coefficient showed that the per capita inpatient reimbursement expenses of the sample individuals would increase by 4009.45 yuan after implementing the policy. The implementation of the policy had a significant positive effect on inpatient reimbursement expenses. The findings above were still valid after robustness testing by replacing the explanatory variables. Based on the findings above, this paper proposes the following recommendations, including improving the responsivity and stability of the settlement system, further promoting the policy with high quality, rationally guiding patients to seek medical treatment in different destinations, and improving the overall utilization rate of medical resources in local places.