我国分级诊疗模式是否能节约医疗资源

Can Tiered Medical Service System in China Save Medical Resources

本研究借鉴2014版的Andersen模型构建分级诊疗与医疗资源利用的理论框架,并基于2008-2014年126个城市的平衡面板数据,利用双重差分法量化评估我国行政主导下的非强制性分级诊疗模式的实施效果,作者首次检验了医疗生产要素规模、人口老龄化程度在分级诊疗对医疗资源利用影响中的调节作用。该研究发现:(1)分级诊疗的实施显著节约了门急诊与住院服务资源利用,并且平行趋势检验、安慰剂检验、PSM-DID等方法的结果仍然稳健。(2)通过异质性分析发现,地区医疗生产要素规模越大,分级诊疗对门急诊服务资源的节约效应越强。(3)地区人口老龄化水平越高,分级诊疗对住院服务资源的节约效应越强。基于上述结果,作者认为在人口老龄化背景下,实施分级诊疗可以优化医疗资源配置,提升医疗服务利用效率,减少医疗资源浪费,但是,我国深化分级诊疗改革,必须平衡不同层级医疗机构之间的利益关系,实现不同层级医疗机构从利益竞争到分工合作。该研究科学论证了我国分级诊疗模式能有效节约门急诊与住院服务资源利用,为人口老龄化背景下完善分级诊疗模式提供理论指导,也为进一步深化医疗体制改革提供借鉴参考。

The tiered medical service system in China is different from mandatory systems adopted by some western countries.It has the following characteristics:in terms of medical service provision,the primary medical service capacity is enhanced while medical consortia are developed to promote cooperation between medical institutions at different levels under the guidance of administrative leadership.In terms of medical service purchase,the differential reimbursement of medical insurance fund guides the masses to participate voluntarily.At present,there are many doubts and criticisms on the tiered medical service system in China.Therefore,this paper empirically tests whether the non-mandatory tiered medical service system guided by administration can achieve the expected effects.Firstly,this paper constructs a theoretical framework of the tiered medical service system and the utilization of medical resources by the 2014 version of Andersen behavioral model of health service use.Secondly,based on the balanced panel data of 126 cities from 2008 to 2014,this paper uses difference-in-differences model to evaluate the implementation effect of the non-mandatory tiered medical service system under the guidance of administration in China.Thirdly,this paper tests whether the scale of medical production factors and population aging have moderating effects on the relationship between the tiered medical service system and the utilization of medical resources.Finally,combined with the empirical results and previous studies,this paper puts forward relevant countermeasures and suggestions to improve the tiered medical service system.The results show that:(1)The implementation of the tiered medical service system significantly saved outpatient and inpatient resources:in terms of outpatient services,the total number of people and per capita outpatient and emergency times of classified diagnosis and treatment decreased significantly.In terms of inpatient services,the average length of stay of discharged patients decreases by 5.54%while the average hospitalization expenses for discharged patients decrease by 13.76%.The results of the parallel trend test,the placebo test and PSM-DID are still robust.(2)Through heterogeneity analysis,further study shows that the scale of medical production factors and population aging have significant moderating effects on the relationship between the tiered medical service system and the utilization of medical resources.The larger the scale of medical production factors is,the more outpatient service resources can be saved by tiered medical service system.(3)Similarly,the higher the level of population aging is,the more inpatient service resources can be saved by tiered medical service system.Based on the above-mentioned results,this paper believes that in the context of an aging population,improving tiered medical service system can optimize the allocation of medical resources and reduce waste of medical resources.However,to deepen the reform of tiered medical service system,it is necessary to balance the interests and realize the transformation from competition to cooperation between medical institutions at different levels.This paper scientifically identifies the impact of the tiered medical service system on the utilization of medical resources.Furthermore,this paper provides theoretical guidance for the improvement of the tiered medical service system under the background of aging population,and also provides reference for deepening the reform of medical services.