医患关系、健康水平与医疗经济负担

Doctor Patient Relationship,Health Level and Medical Economic Burden

基于中国家庭追踪调查(CFPS)2014、2016和2018年三期数据、《中国卫生和计划生育统计年鉴》省级宏观层面数据和互联网搜索指数,使用固定效应模型和工具变量法实证检验医患关系对患者个体层面的健康与医疗费用经济负担的影响,分析医患关系对患者健康和医疗经济负担的长期影响。研究发现:(1)医患关系的恶化会降低居民的健康水平,增加个体的医疗经济负担并显著提升总体的医疗费用支出,这一结论在考虑内生性问题和替换核心解释变量等稳健性检验后依然成立。(2)医患关系的影响在地区层面、收入水平层面和医疗机构层面表现出显著的异质性。(3)医患关系对居民健康与医疗经济负担的影响机制能从医疗服务的供给侧(医生)和需求侧(患者)两个层面进行解释,从长期来看,医患关系对于居民健康与医疗经济负担也会呈现显著的影响。据此从厘清医患关系中的供需主体、厘清医患主体中的本位诉求、进一步协同中国医疗保障体系等方面提出政策建议。

Based on the data of China Household tracking survey(CFPS)in 2014,2016 and 2018,the provincial macro level data of China Health and family planning statistical yearbook and the Internet search index,the fixed effect model and instrumental variable method are used to empirically test the impact of doctor-patient relationship on the health and medical cost economic burden of patients at the individual level,and analyze the long-term impact of doctor-patient relationship on the health and medical economic burden of patients.The study found that:(1)the deterioration of the doctor-patient relationship will reduce the health level of residents,increase the individual medical economic burden and significantly increase the overall medical expenses.This conclusion is still valid after considering the endogenous problems and replacing the core explanatory variables.(2)The impact of doctor-patient relationship shows significant heterogeneity at the regional level,income level and medical institution level.(3)The impact mechanism of doctor-patient relationship on residents’health and medical economic burden can be explained from the supply side(doctors)and demand side(patients)of medical services.In the long run,the doctor-patient relationship will also have a significant impact on residents’health and medical economic burden.Therefore,policy suggestions are put forward from the aspects of clarifying the supply and demand subjects in the doctor-patient relationship,clarifying the standard demands in the doctor-patient subjects,and further coordinating China’s medical security system.