目的: 分析广西城乡困难群体医疗救助在住院与门诊间的支出结构失衡状况,探讨不同身份群体的救助差异,为优化资金配置提供参考。方法: 收集2022—2024年广西14个地级市城乡低保对象与特困人员的门诊慢特病和住院救助数据,采用描述性统计、t检验、方差分析及多元线性回归与线性混合模型进行分析。结果: （1）住院人均救助支出1585.67±196.63元,显著高于门诊185.54±71.53元,约为8.5倍（P<0.001）,结构性失衡突出;（2）低保与特困总体救助水平无显著差异（P>0.05）,但就医类型与人员身份交互项显著为正（β=0.754,P<0.001）,住院端特困救助高于低保,门诊端则相反;（3）2022—2024年各年度间救助水平差异无统计学意义（P>0.05）,混合模型结果稳健。结论: 广西医疗救助总体保障水平较为均衡,但存在“重住院、轻门诊”的结构性失衡,特困人员门诊保障处于相对劣势,近三年救助水平总体保持稳定,但地区间配置差异显著。建议适度提高门诊慢特病救助标准,探索与就医类型挂钩的梯度化救助方案,建立救助标准动态调整机制,逐步缩小救助对象内部及区域间的保障水平差距。

Objective: The paper analyzes the structural imbalance in medical assistance expenditure between inpatient and outpatient services for disadvantaged groups in Guangxi, and explores assistance differences across identity groups, providing a reference for optimizing fund allocation. Methods: Data on outpatient chronic and special disease and inpatient assistance for subsistence allowance recipients and extremely poor individuals across 14 prefecture-level cities in Guangxi (2022-2024) were collected. Descriptive statistics, t-tests, ANOVA, multiple linear regression, and linear mixed models were employed. Results: (1) Per capita inpatient assistance (1585.67±196.63 yuan) was significantly higher than outpatient assistance (185.54±71.53 yuan), approximately 8.5 times as high (P<0.001). (2) No significant difference was found in overall assistance between the two groups (P>0.05), but the interaction between care type and identity group was significant (β=0.754, P<0.001): extremely poor individuals received higher inpatient assistance while subsistence allowance recipients received higher outpatient assistance. (3) No significant annual differences were observed across 2022-2024 (P>0.05), with robust mixed model results. Conclusion: Medical assistance in Guangxi is relatively balanced, yet prioritizes inpatient care to the disadvantage of the extremely poor in outpatient services. Assistance levels have remained stable over three years, though intercity disparities are widening. Recommendations include raising assistance standards of outpatient chronic and special disease, exploring a graded scheme linked to care types, establishing a dynamic adjustment mechanism for assistance standards, and gradually narrowing the gaps in security levels within the assistance groups and across regions.