目的: 本研究旨在评估职工医保门诊统筹政策对中老年慢性病患者就医行为选择及就医次数的影响,为优化医保政策提供科学依据。方法: 基于2018年和2020年的中国健康与养老追踪调查（CHARLS）全国数据,运用实证研究手段,全面评估职工医保门诊统筹政策对参保人群在门诊和住院服务利用方面的具体影响,剖析政策在不同疾病类型和年龄群体中的差异。结果: 门诊统筹政策有效提高了参保职工对门诊服务的利用率,但也显著减少了住院服务的使用,同时对患有骨骼肌肉系统疾病的中老年慢性病患者选择门诊医疗服务的概率影响更显著。结论: 职工医保门诊统筹政策提高了中老年慢性病患者门诊医疗利用率,降低了住院概率,对不同疾病及不同年龄段中老年职工影响有差异,建议提高保障水平、优化可及性、建立分层精准保障机制。
Abstract
Objective: This study aims to evaluate the impact of the outpatient pooling policy of employees’ medical insurance on the choice of medical treatment behavior and the frequency of medical treatment for middle-aged and elderly patients with chronic diseases, providing a scientific basis for optimizing medical insurance policies. Methods: Based on the national data of the China Health and Retirement Longitudinal Study (CHARLS) in 2018 and 2020, a comprehensive assessment was conducted on the specific impact of the outpatient pooling policy of the employees’ medical insurance on the utilization of outpatient and inpatient services by the insured population by empirical research methods. At the same time, the differences of the policy among different disease types and age groups were analyzed. Results: The research finds that the outpatient pooling policy effectively increases the utilization rate of outpatient services by insured employees, but significantly reduces the use of inpatient services. Meanwhile, this policy has a more significant impact on the probability of middle-aged and elderly insured employees with musculoskeletal system diseases choosing outpatient medical services. Conclusion: The outpatient pooling policy of employees’ medical insurance improves the utilization rate of outpatient medical care for middle-aged and elderly employees with chronic diseases and reduces the probability of hospitalization. However, the impact on middle-aged and elderly employees with different diseases and age groups varies. It is suggested to enhance the level of security, optimize accessibility, and establish a stratified and precise security mechanism.
关键词
职工医保 /
门诊统筹制度 /
慢性病 /
医疗服务利用
Key words
employees’ medical insurance /
outpatient pooling system /
chronic diseases /
utilization of medical services
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基金
中南民族大学四部委铸牢中华民族共同体意识研究基地招标项目重点课题“中华民族共同体建设的财税路径研究”（JDZ24006）
