家庭医生执业规模对其诊疗行为和接诊患者的医疗费用的影响研究——基于两水平模型的分析

Impact of Panel Size on Family Physicians’ Practice Behaviors and Patients’ Healthcare Cost--Analysis Based on a Two-level Model

合理的家庭医生执业规模是保障签约群体获取基本医疗保障、提高医疗服务利用效率的有效方式。基于2019年在厦门、杭州、上海以及北京等地对在岗和可远程参与诊疗的420名家庭医生的调查发现:家庭医生执业规模上升,则其每日接诊人数、签约居民就诊次数占总门诊比例、月接诊患者总费用和接诊患者次均费用呈增加趋势,但平均接诊时间在减少;相同执业规模对于不同机构的家庭医生诊疗行为以及接诊患者的医疗费用的影响也有差异。所以,家庭医生执业规模应设计在一个相对合理的区间,从而保证生产率和服务质量的平衡。另外,家庭医生的执业规模应该与医疗保险补偿相联系,以减轻患者疾病经济负担,提高基本医疗保障水平。

Optimal panel size is an effective way to ensure that the contracted groups obtain basic medical security and improve the efficiency of health service utilization.Based on the investigation of 420 family physicians in Xiamen,Hangzhou,Shanghai and Beijing in 2019,this study has the following findings:With the increase of larger panel size of family physicians,the number of daily consultations,the proportion of contracted residents'visits to total outpatient visits,as well as total monthly medical expenses of patients and average medical expenses per visit has an increasing trend,but their average consultation time is decreasing.The same panel size has different impact on the family physicians’practice behaviors and patients'healthcare cost.Therefore,the panel size of family physicians should be designed in a relatively reasonable range to ensure the balance between productivity and service quality.In addition,the panel size of family physicians should be related to the health insurance,so as to reduce the economic burden of patients and improve the level of basic medical security.