整合型照护与医疗费用控制--基于“认知友好社区”试点的研究

Integrated Care and Medical Expenditure Control:A Research Based on Pilots of“Cognitive-friendly Communities”

整合型照护有助于提高医疗服务效率,其成为控制医疗费用过快增长的重要途径。文章利用“认知友好社区”试点,考察这一针对慢性病防治的整合型照护模式对医疗服务利用的影响,并进行福利分析。文章使用某典型城市的老年照护统一需求评估、医保账户等数据,采用双重差分的方法,研究发现“认知友好社区”试点会使失能老人住院概率降低3%。进一步结合长期护理保险制度以及相关的异质性分析,研究发现“认知友好社区”试点对男性、城镇职工医疗保险参保人、中重度失能人群住院次数的影响更为明显。文章的影响机制是通过信息效应改善健康行为和跨部门照护资源协作来提高照护质量。最终福利分析发现,“认知友好社区”试点不仅提高失能老人的健康水平,且具有较好的经济效应。文章研究表明,促进以社区为重点的整合型照护模式发展具有推广示范作用,未来应大力推广跨部门协作。文章结论对于解决老龄化问题和医疗服务体系改革具有一定的参考意义。

The traditional medical and health service system with disease and treatment as the core and characteristic of care fragmentation lacks service efficiency and causes waste of medical resources,so it cannot cope with the great challenges brought by the rapid aging process.Integrated care allows patients to receive continuity of care through collaboration among different types of care providers,which not only helps to improve service efficiency,but also becomes an important way to control the rapid growth of medical expenditure.This paper takes the policy of"Cognitive-friendly Communities"as an example to investigate the impact of integrated care for chronic disease prevention and treatment on medical service utilization and carry out welfare analysis.Using the data of disabled elderly assessment and medical insurance accounts in a typical city and the DID method,the study finds that"Cognitive-friendly Communities"can significantly reduce the hospitalization probability of disabled elderly people by 3%below the significance level of 1%.Further combined with the long-term care insurance system and related heterogeneity analysis,it finds that the effect is more significant among male,group who participate in urban employee medical insurance,and moderate and severe disabilities.The possible mechanism is that"Cognitive-friendly Communities"can improve health behavior through information and improve the quality of care through inter-departmental care resource collaboration to improve service efficiency.In addition,the welfare analysis finds that integrated care not only improves the health level of disabled elderly people,but also has a better economic effect.This paper discusses for the first time that the integrated care mode of cognitive disorder prevention and treatment can control the increase of medical expenditure by improving service efficiency from the economic perspective of cause-andeffect identification,which complements the gap in this research field.At the same time,combined with the long-term care insurance system,it explains the impact mechanism from the perspective of inter-departmental cooperation between care resources.The results show that the community-focused integrated care mode for chronic disease prevention and treatment has a promoting and demonstrating role.In the future,it is necessary to vigorously promote the inter-departmental collaboration to improve the health level and reduce medical expenditure,and use the concept of integrated care to deal with the challenge of"fragmented"medical service system in China.