| 引用本文：杨帆.职工门诊保障水平提升对医疗服务利用、医保基金支出的影响——基于福建省三明市的案例分析[J].中国卫生政策研究,2021,14(9):8-13 |
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| 职工门诊保障水平提升对医疗服务利用、医保基金支出的影响——基于福建省三明市的案例分析 |
| 投稿时间：2021-07-13 修订日期：2021-09-17 PDF全文浏览 HTML全文浏览 |
| 杨帆 |
| 中国人民大学公共管理学院 健康保障研究中心 北京 100872 |
| 摘要:本研究基于福建省三明市政府所公布的公立医院运行、医保基金使用月度数据，使用中断时间序列研究方法，分析了三明市职工医保门诊保障水平提升后，区域内医疗服务利用以及医保基金支出状况的变化。研究发现，政策干预后：三明市职工医保参保群体门诊就诊需求得到释放；参保群体对住院服务与门诊服务的利用之间发生了一定程度的置换；区域内分级诊疗秩序构建态势良好；职工医保统筹基金支出趋势未发生明显变化。基于上述结论，本研究建议采取多样化措施促进分级诊疗、完善门诊医师薪酬待遇及药品供应等配套政策、将公共卫生与门诊保障政策相衔接等。 |
| 关键词:职工医保 门诊保障 报销比 医疗服务 医保基金 |
| 基金项目:中国人民大学“中央高校建设世界一流大学（学科）和特色发展引导专项资金”（2022022） |
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| Influence of the improvement of outpatient security level of employees on the utilization of medical services and the expenditure of medical insurance funds: Based on the case analysis of Sanming City, Fujian Province |
| YANG Fan |
| Health Security Research Center, School of Public Administration, Renmin University of China, Beijing 100872, China |
| Abstract:This Study analyzes the changes in medical service utilization and medical insurance fund expenditure in Sanming City after the improvement of medical insurance outpatient security level based on the monthly data of public hospital operation and medical insurance fund use published by Sanming Municipal Government of Fujian Province. It is found that after the policy intervention, the outpatient demand of employees' medical insurance insured groups in Sanming City is released. There has been a certain degree of replacement between the utilization of inpatient services and outpatient services by the insured groups. The establishment of graded diagnosis and treatment order in the region is in good shape. There is no obvious change in the expenditure trend of employee medical insurance pooling funds. This study puts forward corresponding policy suggestions based on the above conclusions, including taking diversified measures to promote graded diagnosis and treatment, improving supporting policies such as outpatient doctors' remuneration and drug supply and linking public health with outpatient security policies. |
| Key words:Employee medical insurance Outpatient service guarantee Reimbursement ratio Medical Services Medical insurance fund |
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