医保政策调整对农村居民门诊医疗费用影响的动态变化

Dynamic Change Research on the Impact of Medical Insurance Policy Adjustment on Outpatient Medical Expenses of Rural Residents

目的 通过研究医保政策调整对农村居民门诊医疗费用影响的动态变化,探讨其多阶段动态变化过程中的阶段性效应及递进性影响。方法 利用宁夏回族自治区“创新支付制度、提高卫生效益”试点项目5年的调查数据,选择15岁以上农村居民作为研究对象,通过倾向得分匹配法及多阶段双重差分模型分析医保政策调整对农村居民门诊医疗费用的影响。结果 政策调整项目干预县及对照县的次均门诊总费用呈逐年上升趋势;干预组的次均门诊自付费用呈波动状态,较基线期(2009年)升高了2.55倍,对照组呈逐年递增状态,到2019年增加至890.52元;基期干预县门诊自付比为90.29%,至2019年与基线期相比降低了15.74%,对照县为86.82%,至2019年降低了6.56%。医保政策调整3年后农村居民的门诊自付比和次均门诊自付费用分别降低了7.63%和52.73%,但后期作用效果不显著。结论 医保政策调整降低了项目干预县农村居民的次均门诊自付费用和自付比,但其影响存在短期性。

Objective This paper studies the dynamic changes of the impact of medical insurance policy adjustment on the outpatient medical expenses of rural residents,and explores the stage effects and progressive effects in the process of multi-stage dynamic changes.Methods Using the five-year survey data of the pilot project of"innovating payment system and improving health benefits"in Ningxia,rural residents over 15 years old were selected as the research objects,and the propensity score matching method and multi-stage double-difference model were used to analyze the effect of medical insurance policy adjustment on outpatient clinics of rural residents.The impact of medical costs.Results The average outpatient cost per time in the intervention and control counties of the policy adjustment project showed an upward trend year by year;the average outpatient cost per time in the intervention group fluctuated and increased by 2.55 times compared with the base period(2009).The increase year by year will increase to 890.52 yuan in 2019;the outpatient outpatient ratio of the intervention counties in the base period is 90.29%,which is 15.74%lower than that in the base period in 2019,and 86.82% in the control counties,which is 6.56%lower in 2019.Three years after the adjustment of the medical insurance policy,the out-patient out-of-pocket ratio and out-of-pocket expenses per outpatient visit of rural residents decreased by 7.63% and 52.73%,respectively,but the effect was not significant in the later period.Conclusion The adjustment of medical insurance policy reduces the out-of-pocket payment and out-of-pocket ratio of rural residents in the project intervention counties,but the impact is short-term.