跨省异地就医直接结算政策对中老年慢性病患者健康状况的影响探究——基于CMDS数据的实证分析

Influence of Direct Settlement for Transprovincial Medical Treatment on the Health Status of the Middle-aged and Elderly with Chronic Diseases——An Empirical Analysis Based on CMDS

如何改善流动人口以及中老年慢性病患者的健康状况成为推动健康中国建设的一项重要议题。本文基于2017年全国流动人口卫生计生动态监测微观数据和异地就医定点医院宏观数据,实证检验跨省异地就医直接结算政策对中老年慢性病患者健康状况的影响。研究表明,政策的实施显著促进了中老年慢性病患者对居住地医疗服务的利用率,发挥了显著的健康促进效果。进一步分析发现,由于政策实施初期并未将门诊服务纳入保障范畴,且患者对大型三级医院更加信赖,因此只有当就医地有纳入联网直接结算的三级医院时,中老年慢性病患者的健康状况才能有效改善。政策效果受中老年慢性病患者的流动模式、经济状况及医疗服务可及性等因素影响,表现出异质性。异地就医政策对不与后代同住、经济状况较差、距离医疗机构更近的中老年人的健康状况影响更大。对此,本文建议健全慢性病患者的异地就医及配套用药保障政策,加大政策的宣传力度、优化备案流程,充分发挥异地就医政策的健康保障功能。

How to improve the health status of middle-aged and elderly floating populations with chronic diseases has become an important health issue in promoting the construction of a healthy China.Based on the micro data of CMDS in 2017 and the macro data of the designated hospitals,this paper empirically examines the impact of immediate reimbursement for transprovincial medical treatments on the health status of the floating middle-aged and elderly with chronic diseases.The results show that this policy can significantly improve the medical utilization rate of medical services in the place of residence for middle-aged and elderly patients with chronic diseases and play a positive role in the health promotion.Analysis shows that due to the fact that outpatient services have not been covered,and patients are more likely to trust large hospitals,this policy makes sense only when there are tertiary hospitals implementing immediate reimbursement in the destination city.Finally,the health effects are heterogeneous with the flow patterns,economic conditions and health care accessibility of this group.Those who do not live with their later generations,have relatively lower income and live close to hospitals are more affected by the policy.It is necessary to improve the transprovincial medical treatment and medication policy for patients with chronic disease,and enhance the publicity of this policy,so as to give full play to the health security function of transprovincial medical treatment policy.