北京大学学报(医学版)
北京大學學報(醫學版)
북경대학학보(의학판)
JOURNAL OF BEIJING MEDICAL UNIVERSITY(HEALTH SCIENCES)
2014年
3期
445-449
,共5页
汤淑女%简伟研%Winnie C-M Yip%郭岩
湯淑女%簡偉研%Winnie C-M Yip%郭巖
탕숙녀%간위연%Winnie C-M Yip%곽암
保险%健康%高血压%卫生服务利用%双重差分法
保險%健康%高血壓%衛生服務利用%雙重差分法
보험%건강%고혈압%위생복무이용%쌍중차분법
Insurance%health%Hypertension%Health services utilization%Difference in differences
目的:研究向基层机构倾斜的门诊报销制度(即覆盖门诊服务且县、乡、村门诊报销比例由低到高的制度设计)对高血压患者门诊服务利用的影响。方法:从宁夏回族自治区“创新支付制度项目”获取2009年和2011年入户调查的面板数据,采用自然试验的设计,针对干预组和对照组,利用双重差分法( difference-in-differences )进行分析,其结果指标为自报高血压患者样本被调查前3个月内是否就诊及其主要就诊地点的选择。结果:相较于对照组,倾向于基层的新农合门诊覆盖使得干预组高血压患者被调查前3个月内从未就诊的概率下降10.2%,并使患者将村卫生室作为主要就诊地点的概率提高了15.7%。结论:门诊报销比例向基层机构倾斜,可以引导高血压患者在疾病风险较小时就近利用门诊服务。
目的:研究嚮基層機構傾斜的門診報銷製度(即覆蓋門診服務且縣、鄉、村門診報銷比例由低到高的製度設計)對高血壓患者門診服務利用的影響。方法:從寧夏迴族自治區“創新支付製度項目”穫取2009年和2011年入戶調查的麵闆數據,採用自然試驗的設計,針對榦預組和對照組,利用雙重差分法( difference-in-differences )進行分析,其結果指標為自報高血壓患者樣本被調查前3箇月內是否就診及其主要就診地點的選擇。結果:相較于對照組,傾嚮于基層的新農閤門診覆蓋使得榦預組高血壓患者被調查前3箇月內從未就診的概率下降10.2%,併使患者將村衛生室作為主要就診地點的概率提高瞭15.7%。結論:門診報銷比例嚮基層機構傾斜,可以引導高血壓患者在疾病風險較小時就近利用門診服務。
목적:연구향기층궤구경사적문진보소제도(즉복개문진복무차현、향、촌문진보소비례유저도고적제도설계)대고혈압환자문진복무이용적영향。방법:종저하회족자치구“창신지부제도항목”획취2009년화2011년입호조사적면판수거,채용자연시험적설계,침대간예조화대조조,이용쌍중차분법( difference-in-differences )진행분석,기결과지표위자보고혈압환자양본피조사전3개월내시부취진급기주요취진지점적선택。결과:상교우대조조,경향우기층적신농합문진복개사득간예조고혈압환자피조사전3개월내종미취진적개솔하강10.2%,병사환자장촌위생실작위주요취진지점적개솔제고료15.7%。결론:문진보소비례향기층궤구경사,가이인도고혈압환자재질병풍험교소시취근이용문진복무。
Objective:To study the impact of primary care oriented outpatient benefits package design of outpatient services coverage and ladder reimbursement of county , town and village levels in the new ru-ral cooperative medical system ( NRCMs) on hypertension outpatient services utilization .Methods:The panel data of treatment and control groups in 2009 and 2011 before and after the policy reform were drawn from the household survey data of the innovative payment system project .The difference in difference ( DID) method was used for data analysis .The outcome indicators included the utilization of outpatient services of patients with self-reported hypertension and their main treatment locations .Results:The pri-mary care oriented outpatient benefit package design in the NRCMs reduced the probability of no treat-ment in the latest three months of hypertension by 10.2 percent points.Meanwhile, it increased the prob-ability of choosing village clinic as the preferred location by 15 .7 percent points .Conclusion: Primary care oriented outpatient benefits package design lead patients with hypertension to use the nearest outpa -tient services at low risk of disease .