城乡居民医保整合后医疗服务利用和费用负担变化研究

A Cohort Study on the Changes of Medical Service Utilization and Cost Burden after the Integration of Basic Medical Insurance System for Urban and Rural Residents

目的:分析城乡居民医保制度整合后,城市居民和农村居民医疗服务利用和费用负担的变化。方法:采用队列研究,以门诊和住院补偿人次、次均费用及住院患者机构流向为分析指标,分析研究队列在2010-2018年间的指标变化情况。结果:城乡居民医保制度整合后,城乡居民在医疗服务利用上的不公平性得到缓解,但在费用负担上的不公平性并未得到有效缓解;医保政策对规范居民就医秩序的作用仍较弱。结论:建立约束机制,强化医保对规范就医行为的作用;调整筹资政策,提高城乡居民医疗费用负担公平性;加快医保支付方式改革,提升基层卫生服务能力。

Objective To analyze the changes of medical service utilization and medical cost burden of urban and rural residents after the integration of basic medical insurance system for urban and rural residents.Methods Taking outpatient and inpatient compensation person times,medical flow and average outpatient and inpatient expenses as the analysis indicators of medical service utilization and medical cost burden,a cohort study was conducted to analyze the changes of these indicators from 2010 to 2018.Results The integration of basic medical insurance system for urban and rural residents alleviated the inequality of medical service utilization between urban and rural residents.However,this effect was not observed in cost burden.The current medical insurance system plays a relatively weak role in regulating patients'medical visits.Conclusions A restraint mechanism should be established to strengthen the normative effect of medical insurance on the medical visits.It is suggested to adjust the financing policy to improve the equality of medical cost burden of urban and rural residents.It is recommended to advance the promotion of the reform of medical insurance payment so as to improve the primary care quality.