医保政策能否促进分级诊疗的实现:基于医疗需求行为的实证分析

Whether Health Insurance Policy Can Promote the Realization of the Hierarchical Medical System: An Empirical Analysis Based on Medical Demand Behavior

在健康中国建设的时代背景下,推进分级诊疗体系建设,必须根据居民的医疗需求行为,采取适当的政策干预,引导居民前往基层医疗机构就医。医疗保险政策能够对医疗需求行为起到调节和促进作用,报销比例越高的医疗机构,越能够吸引居民就医。医疗服务价格的影响存在城乡差异,城镇居民对于价格因素不敏感。收入对医疗需求行为具有明显的分化作用,由于基层医疗机构的服务质量偏低,收入提高以后,居民很可能放弃医疗保险的报销政策,自付费用前往高质量的医院就诊。为了推进分级诊疗体系建设,必须充分发挥医疗保险政策的市场调节作用,引导优质医疗资源下沉,提高基层医疗机构的服务能力和服务质量。

Under the strategy of building a Healthy China, the hierarchical medical system must be developed based on residents＇ medical needs, and appropriate policy intervention should be carried out to guide residents to primary medical institutions for medical treatment. Health insurance policy can regulate and promote medical - demand behavior. Those medical institutions with a higher proportion of reimbursement could attract more patients. There are differences in the impact of the price of medical serv- ices between urban and rural areas. Urban residents are not sensitive to price factors. Income has a significant a differentiation effect on medical behavior. As for the low quality of primary health care institutions, residents with higher income are likely to give up the health insurance reimbursement policy, paying their own fees to high - quality hospital treatment instead. In order to promote the development of the hierarchical treatment system, we must give full play to the role of health insurance policy, and guide the quality of medical resources to lower levels, and improve grassroots medical institutions, service and service quality.