向基层机构倾斜的门诊报销制度对高血压患者门诊服务利用的影响

Impact of primary care oriented outpatient benefit package design in new rural cooperative medical system on hypertension outpatient services utilization

目的:研究向基层机构倾斜的门诊报销制度(即覆盖门诊服务且县、乡、村门诊报销比例由低到高的制度设计)对高血压患者门诊服务利用的影响。方法:从宁夏回族自治区"创新支付制度项目"获取2009年和2011年入户调查的面板数据,采用自然试验的设计,针对干预组和对照组,利用双重差分法(difference-in-differences)进行分析,其结果指标为自报高血压患者样本被调查前3个月内是否就诊及其主要就诊地点的选择。结果:相较于对照组,倾向于基层的新农合门诊覆盖使得干预组高血压患者被调查前3个月内从未就诊的概率下降10.2%,并使患者将村卫生室作为主要就诊地点的概率提高了15.7%。结论:门诊报销比例向基层机构倾斜,可以引导高血压患者在疾病风险较小时就近利用门诊服务。

Objective：To study the impact of primary care oriented outpatient benefits package design of outpatient services coverage and ladder reimbursement of county , town and village levels in the new ru-ral cooperative medical system （ NRCMs） on hypertension outpatient services utilization .Methods：The panel data of treatment and control groups in 2009 and 2011 before and after the policy reform were drawn from the household survey data of the innovative payment system project .The difference in difference （ DID） method was used for data analysis .The outcome indicators included the utilization of outpatient services of patients with self-reported hypertension and their main treatment locations .Results：The pri-mary care oriented outpatient benefit package design in the NRCMs reduced the probability of no treat-ment in the latest three months of hypertension by 10.2 percent points.Meanwhile, it increased the prob-ability of choosing village clinic as the preferred location by 15 .7 percent points .Conclusion： Primary care oriented outpatient benefits package design lead patients with hypertension to use the nearest outpa -tient services at low risk of disease .