摘要
目的:验证门诊服务和住院服务的替代关系,为门诊服务保障政策的设计提供参考依据。方法:采集中国东部某地区13个区县2007年至2013年新型农村合作医疗年度报表,利用"固定效应"模型,分析以区县为单位门诊次数、门诊费用和门诊报销金额对住院服务次数、住院费用和住院报销金额的影响。结果:门诊次数每增加1次,可以节约20元的住院费用;门诊报销金额每增加1万元,住院费用下降0.97万元;门诊费用每增加1万元,住院报销金额降低0.30万元;门诊服务并不增加住院次数。门诊对住院的影响,主要集中在区县级医疗机构,对市及以上更高级医疗机构住院影响并不显著。结论:门诊服务对住院服务有一定的替代作用。疾病保障基金在分配门诊和住院的报销费用时,应当充分考虑门诊服务对住院服务的替代作用,适当地向门诊服务倾斜。
Objective：To study the substitution effect of outpatient services on inpatient services and provide suggestions on designing outpatient policies. Methods：The data were from 13 districts/counties in one area of eastern China from 2007 to 2013 for the new cooperative medical scheme. This study em-ployed a fixed effects model to analyze the impacts of outpatient visit times, expenditure amounts and re-imbursements on inpatient services. Results： One outpatient visit reduced the total amount of inpatient services by 20 Yuan. An increase of 10 000 Yuan outpatient reimbursements saved 9 700 Yuan inpatient expenses. An increase of 10 000 Yuan outpatient expenses led to a decrease of 3 000 Yuan inpatient re-imbursements. The outpatient services did not increase the inpatient hospitalization times significantly. In particular, the effects of the outpatient services were mainly on the inpatient services at the district/coun-ty levels, and no significant impacts on the outpatient services at the city levels. Conclusion：There is a substitution effect of outpatient services on inpatient services. The health insurance departments should take this substitution effect into account and shift more funds on outpatient series, when they design out-patient and inpatient reimbursement policies.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2015年第3期459-463,共5页
Journal of Peking University:Health Sciences
基金
国家自然科学基金(71373013)资助~~
关键词
门诊服务
住院服务
保险
报销政策
新型农村合作医疗
Outpatient services
Inpatient services
Insurance
Reimbursement policy
New cooperative medical scheme
