建立门诊统筹基金对经济保障的长期影响:来自中国准自然实验的经验证据。

IF 1.9 4区 医学 Q3 HEALTH POLICY & SERVICES
Tao Zhang, Minyan Chen
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引用次数: 0

摘要

背景:中国全民医保的门诊医疗福利有限,导致门诊自付费用过高,甚至出现医疗贫困。中国城镇职工基本医疗保险引入了门诊统筹基金模式,以减少门诊费用的分担。本研究试图探讨门诊统筹对参保人经济风险保障的动态影响:方法:从中国健康与营养调查(2000-2015 年)的六次调查中提取了 18,097 个个体水平观测值,覆盖 52 个县。采用多期差分模型和事件研究,探讨改革对灾难性医疗支出(CHE)和贫困性医疗支出(IHE)的动态影响及潜在机制:结果表明,门诊统筹计划对降低灾难性医疗支出(β = -0.004,95% CI = -0.009--0.006)和贫困性医疗支出(β = -0.007,95% CI = -0.012--0.001)的发生概率有显著效果,尤其是对 60 岁以上的老年人。这一效果的实现可能取决于改革后门诊费用分担的减少、门诊护理利用率的提高以及住院护理利用率的降低。然而,活动研究发现,与政策实施初期相比,门诊统筹减少 CHE 和 IHE 发生率的效果在最近几年似乎较弱,甚至不明显:结论:在中国,建立门诊统筹制度可有效缓解医疗支出带来的财务风险。结论:建立门诊统筹制度可有效缓解中国医疗支出所带来的财务风险,而优化医疗服务、提高医保购买效率则是保持政策有效性的当务之急。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term effects of establishing outpatient pooling funds on financial protection: Empirical evidence from a quasi-natural experiment in China.

Background: A limited benefit package for outpatient care in Chinese universal health coverage led to high out-of-pocket outpatient payments, and even medical impoverishment. The outpatient pooling fund model was introduced in China's Urban Employee Basic Medical Insurance to reduce cost-sharing for outpatient care. This study attempts to examine the dynamic effects of the outpatient pooling scheme on financial risk protection for its enrollees.

Methods: A total of 18,097 individual-level observations covering 52 prefectures were extracted from six waves of China Health and Nutrition Survey (2000-2015). The difference-in-differences model with multiple periods and event study were employed to investigate the dynamic effects of reform on catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE) and potential mechanisms.

Results: Our results showed outpatient pooling scheme generated a significant effect on reducing the probability of incurring CHE (β = -0.004, 95% CI = -0.009 to -0.006) and IHE (β = -0.007, 95% CI = -0.012 to -0.001), especially for elderly people over 60 years old. The realization of this effect may depend on the reduction of outpatient cost-sharing, increased outpatient care utilization, as well as decreased inpatient care utilization after reform. However, event study found the effectiveness of outpatient pooling reducing CHE and IHE occurrences appeared to be weak even insignificant in more recent years relative to the initial years of policy implementation.

Conclusions: Establishing an outpatient pooling system is effective to alleviate the financial risk caused by health expenditures in China. Optimising health service delivery aimed at enhancing health insurance purchasing efficiency are deemed imperative for sustaining the policy effectiveness.

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来源期刊
CiteScore
4.50
自引率
3.70%
发文量
197
期刊介绍: Policy making and implementation, planning and management are widely recognized as central to effective health systems and services and to better health. Globalization, and the economic circumstances facing groups of countries worldwide, meanwhile present a great challenge for health planning and management. The aim of this quarterly journal is to offer a forum for publications which direct attention to major issues in health policy, planning and management. The intention is to maintain a balance between theory and practice, from a variety of disciplines, fields and perspectives. The Journal is explicitly international and multidisciplinary in scope and appeal: articles about policy, planning and management in countries at various stages of political, social, cultural and economic development are welcomed, as are those directed at the different levels (national, regional, local) of the health sector. Manuscripts are invited from a spectrum of different disciplines e.g., (the social sciences, management and medicine) as long as they advance our knowledge and understanding of the health sector. The Journal is therefore global, and eclectic.
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