医保报销待遇与患者异地就医选择——基于空间距离、医院等级和医保待遇的分析

Medical Insurance Reimbursement Benefits and Patients’Choice of Cross-region Medical Treatment:Based on Spatial Distance,Hospital Level and Medical Insurance Benefits

在优质医疗资源区域分布失衡与医疗保险属地化管理的背景下,异地就医可更好地满足患者需求,但也可能带来欠发达地区医保基金收支不平衡问题。本文考察医保待遇、就医距离和医院等级对患者选择的影响,并重点探讨异地就医医保报销待遇和患者距离支付意愿之间的关系。利用某医疗资源匮乏地区肿瘤患者的医疗保险报销数据发现,相对于本地医院,重症患者更愿意前往省会城市三级医院就医,他们愿意付出更高的额外距离成本,轻症患者的距离支付意愿较低。随着医保待遇的提升,患者的预期自付比例下降,重症患者对异地就医的距离支付意愿显著上升,但轻症患者的距离支付意愿变动不大。相较于城市患者,农村重症患者的距离支付意愿较低,但对医保报销待遇的变化更敏感。本文结果表明,异地就医报销待遇应考虑疾病差异和城乡差距,以提升基金使用效率和公平性。

In China,the basic medical insurance system operates under the principle of localized management,with counties(cities)as the primary administrative units.This system ensures that the financing and insurance benefits provided are commensurate with the local economic development.However,the uneven regional distribution of high-quality medical resources across the country makes many patients in underdeveloped regions seek medical treatment outside their regions.On the one hand,cross-region medical treatment provides patients with access to superior healthcare resources,thereby enhancing their well-being.On the other hand,this phenomenon contributes to the flow of medical insurance funds from underdeveloped regions to more affluent areas,further aggravating the imbalance in medical insurance fund allocation and the inequitable distribution of regional healthcare resources in underprivileged regions.In light of the progressive implementation of China’s direct settlement policy for cross-region medical treatment,there has been a discernible upward trajectory in insured residents seeking healthcare beyond their local regions,which poses a heightened challenge to the financial stability of local medical insurance funds.Thus,it is imperative to improve the medical insurance benefits for cross-region medical treatment to allocate limited healthcare resources to alleviate the burden of major and severe illnesses for insured individuals.This study examines the impact of medical insurance reimbursement benefits,travel distance,and hospital level on patients’choice of cross-region hospitals,focusing on the relationship between crossregion medical insurance benefits and patients’willingness to travel.The findings provide policy insights for the effective allocation of medical insurance funds.Utilizing administrative medical insurance reimbursement data from a less-developed region in Anhui province,where healthcare resources are relatively scarce,we find that patients with different disease severities have preferences when seeking cross-region medical treatment.Patients with less severe conditions,such as benign tumors,have a greater inclination toward tertiary hospitals in noncapital cities.Critically ill patients,such as those with malignant tumors,have a strong preference for tertiary hospitals in provincial capital cities,followed by tertiary hospitals in noncapital cities.Specifically,critically ill patients are willing to travel an additional distance of 176.3 kilometers to receive treatment in tertiary hospitals located in provincial capital cities.Furthermore,as the reimbursement benefits for cross-region medical treatment improve and patient cost-sharing decreases,critically ill patients have an increased willingness to travel.Conversely,patients with less severe conditions display relatively stable preferences regarding travel.In addition,this study reveals urban-rural disparities in patients’choice of cross-region medical treatment.Rural patients have a lower willingness to travel compared with their urban counterparts and have higher sensitivity to changes in cross-region medical insurance benefits.This highlights the importance of considering the unique needs and preferences of patients in different regions and with different disease severities when designing policies to improve access to cross-region medical treatment.This study contributes to the existing literature in several ways.First,it expands on our understanding of patients’choices in the context of cross-region medical treatment,adding to the existing literature on patient healthcare decision-making,where patients’choice sets are restricted to local hospitals.Second,we consider healthcare prices as a crucial factor in patients’choice of hospital,which is often overlooked in previous studies that utilize discrete choice models to explore patients’choices.In recent years,despite the expansion in coverage of medical insurance,patients still face considerable outof-pocket medical expenses,with cross-region patients experiencing even higher financial burdens.Third,our study examines the urban-rural disparities in patient preferences for cross-region medical treatment.Existing research has noted substantial disparities in healthcare utilization between urban and rural residents in China.In contrast,our findings shed light on a notable urban-rural discrepancy in the availability of cross-region high-quality medical resources for critically ill patients.We suggest that governments should prioritize higher medical reimbursement for critically ill patients and those residing in rural areas,which can improve the efficiency and fairness of medical insurance fund allocation.