如何改善流动人口以及中老年慢性病患者的健康状况成为推动健康中国建设的一项重要议题。本文基于2017年全国流动人口卫生计生动态监测微观数据和异地就医定点医院宏观数据,实证检验跨省异地就医直接结算政策对中老年慢性病患者健康状况的影响。研究表明,政策的实施显著促进了中老年慢性病患者对居住地医疗服务的利用率,发挥了显著的健康促进效果。进一步分析发现,由于政策实施初期并未将门诊服务纳入保障范畴,且患者对大型三级医院更加信赖,因此只有当就医地有纳入联网直接结算的三级医院时,中老年慢性病患者的健康状况才能有效改善。政策效果受中老年慢性病患者的流动模式、经济状况及医疗服务可及性等因素影响,表现出异质性。异地就医政策对不与后代同住、经济状况较差、距离医疗机构更近的中老年人的健康状况影响更大。对此,本文建议健全慢性病患者的异地就医及配套用药保障政策,加大政策的宣传力度、优化备案流程,充分发挥异地就医政策的健康保障功能。
Abstract
How to improve the health status of middle-aged and elderly floating populations with chronic diseases has become an important health issue in promoting the construction of a healthy China. Based on the micro data of CMDS in 2017 and the macro data of the designated hospitals, this paper empirically examines the impact of immediate reimbursement for transprovincial medical treatments on the health status of the floating middle-aged and elderly with chronic diseases. The results show that this policy can significantly improve the medical utilization rate of medical services in the place of residence for middle-aged and elderly patients with chronic diseases and play a positive role in the health promotion. Analysis shows that due to the fact that outpatient services have not been covered, and patients are more likely to trust large hospitals, this policy makes sense only when there are tertiary hospitals implementing immediate reimbursement in the destination city. Finally, the health effects are heterogeneous with the flow patterns, economic conditions and health care accessibility of this group. Those who do not live with their later generations, have relatively lower income and live close to hospitals are more affected by the policy. It is necessary to improve the transprovincial medical treatment and medication policy for patients with chronic disease, and enhance the publicity of this policy, so as to give full play to the health security function of transprovincial medical treatment policy.
关键词
异地就医 /
直接结算 /
慢性病 /
中老年人 /
流动人口
Key words
transprovincial inpatient treatments /
immediate reimbursement /
chronic disease /
middle-aged and elderly persons /
floating populations
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 国家卫生健康委员会.中国流动人口发展报告2018[M].北京:中国人口出版社,2018:3-11.
[2] KONG L N, ZHANG N, YUAN C, et al.Relationship of social support and health-related quality of life among migrant older adults: the mediating role of psychological resilience[J]. Geriatric Nursing, 2021, 42(1):1-7.
[3] 张静茹,倪冰莹,纪颖,等.中国老年流动人口健康状况及卫生服务利用分析[J].现代预防医学,2017,44(19):3526-3530.
[4] SHIGEOKA H.The effect of patient cost-sharing on utilization, health and risk protection[J]. The American Economic Review,2014, 104(7):2152-84.
[5] 杨华磊,廖佩凡.综合医改是否缓解了“看病贵”——以中老年群体医疗费用影响因素分析为例[J].中国医疗保险,2023(03):84-92.
[6] 国家医疗保障局.全国医疗保障跨省异地就医直接结算公共服务信息(第五十五期)[EB/OL].(2023-02-02)[2023-03-13].http://www.gov.cn/xinwen/2023-02/02/content_5739643.htm,2023-02-02/2023-2-25.
[7] 章迟,郭珉江,刘阳.我国跨省异地就医直接结算业务协同机制建设及成效初探[J].中国医疗保险,2021(12):27-32.
[8] 王煜昊,王丽娜,梁丽蕙,等.跨省异地就医的医保基金监管路径研究[J].卫生经济研究,2023,40(04):61-65+69.
[9] 白兰,顾海.异地就医结算背景下医保参保地差异对老年流动人口医疗资源利用的影响研究[J].兰州学刊,2021(05):181-196.
[10] PAN Y, ZHONG W, YIN R, et al.Does direct settlement of intra-province medical reimbursements improve financial protection among middle-aged and elderly population in China? Evidence based on CHARLS data[J]. Social Science & Medicine, 2022, 308,115-187.
[11] 刘建国,苏文杰.“银色数字鸿沟”对老年人身心健康的影响——基于三期中国家庭追踪调查数据(CFPS)[J].人口学刊,2022,44(06):53-68.
[12] 张聪,陈家言,马骁.流动人口社会融合与健康促进[J].现代预防医学,2015,42(08):1519-1522.
[13] LIU G, VORTHERMS S, HONG X.China's Health Reform Update[J]. Annual Review of Public Health,2017,38:43-48.
[14] 何文,申曙光.门诊统筹改变了农村中老年人的医疗行为吗——来自医疗保险微观报销数据的经验证据[J].农业技术经济,2022, 329(09):74-87.
[15] FENG J, SONG H, WANG Z.The elderly's response to a patient cost-sharing policy in health insurance: Evidence from China[J]. Journal of Economic Behavior & Organization,2020, 169:189-207.
[16] 陶涛,钟雨奇,黄静怡.“单方索取”还是“相互需要”代际同住中的需求组合与亲子选择[J].社会,2022,42(06):214-240.
[17] 詹鹏,尹丽萍,叶林祥.农村居民间接医疗费用研究——基于安徽舒城县的调查[J].中国农村观察,2021, 159(03):48-66.
[18] STARFIELD B, SHI L, MACINKO J.Contribution of primary care to health systems and health[J].The Milbank Quarterly,2005, 83:457-502.
[19] 刘璐婵. 老年流动人口异地就医:行为特征、支持体系与制度保障[J].人口与社会,2019,35(01):39-51.
基金
湖南省自然科学基金青年科学基金项目“医保异地即时结算对流动人口参保意愿及健康状况的影响研究”（2021JJ40127）; 国家自然科学基金青年科学基金项目“医疗保险对慢性病门诊治疗的引导作用、保障效果及政策优化研究”（72204079）
