按人头付费与开放式首诊改革:基于城居保入户调查分析

Capitation Payment and Open Enrollment Policy Reform: Based on Urban Resident Basic Medical Insurance Household Survey

目的:考察湖南省常德市城镇居民基本医疗保险住院付费方式改革的成效,包括按人头付费与开放式首诊改革政策。方法:利用城镇居民基本医疗保险入户调查的面板数据,采用普通最小二乘法(OLS)、有序Probit等方法。结果:主要有3个结果,(1)按人头付费及开放式首诊改革政策显著降低了住院患者自付费用以及平均住院日;(2)总住院费用和患者满意度并没有显著变化;(3)稳定性检验的结果表明,基于自评健康较差人群的回归结果与基于全样本的结果类似。结论:常德的按人头付费及其配套政策减轻了患者的经济负担、缩短了住院时间,但是并未降低总医疗费用,同时也没有降低患者的满意度。

Objective： To evaluate the effects of payment reform for Changdu Urban Resident Basic Medical Insurance in Hunan, including capitation payment and open enrollment policy reform. Methods： Pane] data from the Urban Resident Basic Medical Insurance Survey was used. The Ordinary Least Squares（OLS） and Ordered Probit models were applied. Results： There were three major findings： （1） the inpatient out-of-pocket expenditure, and average length of stay were both significantly decreased; （2） the total inpatient expenditure and patients＇ satisfaction remained unchanged; （3） the results of robust test showed that the regression result based on people who＇s self-health evaluation, which was weak was similar to the result of the whole sample. Conclusion： In Changde, capitation and the supporting policy had relieved the economic burden of patients and shortened inpatient length, however, it did not decrease the total medical costs while the patient satisfaction remain unchanged. It is concluded that the payment reform in Changde has reduced out-of-pocket expenditure and length of stay, while the total inpatient expenditure and patient satisfaction remain unchanged.