签约家庭医生对居民医疗费用的影响分析

Analysis on the Effect of Family Doctor Contraction on Residents' Medical Expenses

目的:通过对居民感受最为直观的医疗费用个人现金支出的分析,探讨签约对缓解居民医疗负担的成效。方法:依托问卷跟踪调查采集上海市协同改革试点长宁区居民数据,通过签约与未签约居民的医疗费用比较、多元回归模型分析签约对医疗费用的影响及作用机制。结果:签约居民医疗费用高于未签约居民,但是在纳入年龄结构与疾病特征后差异消失;模型检验结果显示2016年签约居民医疗费用低于未签约居民593.6元,而在2013年签约居民费用仍然高于未签约居民;在认知、行为与慢病服务三大作用机制中,对社区卫生服务中心地点知晓、就诊医疗机构选择是家庭医生影响个人医疗费用的重要因素,慢病服务还未发挥作用。结论:年龄与疾病结构导致了签约居民个人现金支出高的假象,随着时间推移签约对医疗费用的抑制作用已初显成效。而依托家庭医生与医保支付方式改革实现医疗费用的管控有赖于有效的健康管理,这还有漫长的道路要走。

Objective： To explore the effect of the signing on relief residents＇ medical burden by analyzing out-of-pocket medi- cal expense which could most intuitively be perceived by residents. Methods： Collecting data of residents from Changning District （Shanghai Synergism Reform Pilot） by following questionnaire survey. Results： Out of pocket（OOP） medical expense of contracted ~si- dents was much higher than the uneontracted, but such difference disappeared after age structure and disease status were controlled; model test showed that the annual OOP medical expense of contracted residents in 2016 was lower than those of unsigned residents by 593.6 yuan, while the contracted residents＇ expense in 2013 was still higher. In terms of the influencing factors of cognition, behav- ior and chronic disease services, knowing the location of community health service center and selecting medical institutions for medi- cal treatment were both significant, through which family doctor affecting the medical expense. But chronic disease services had not yet played a role. Conclusion： The age and disease structure led to the illusion that contracted residents had higher medical costs. The management and control of medical expenses, based on family doctors and medical insurance reform, highly relied on the effective implementation of health management, in which still had a long way to go.