| 引用本文：徐鹏宇,姚尧,赵林度.“门诊+住院”捆绑整合支付对普通肺结核患者卫生服务利用的影响研究 ——基于河北省某市的实证分析[J].中国卫生政策研究,2025,18(2):8-15 |
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| “门诊+住院”捆绑整合支付对普通肺结核患者卫生服务利用的影响研究 ——基于河北省某市的实证分析 |
| 投稿时间：2024-11-15 PDF全文浏览 HTML全文浏览 |
| 徐鹏宇,姚尧,赵林度 |
| 东南大学经济管理学院 江苏南京 211189 |
| 摘要:目的:探讨“门诊+住院”捆绑整合支付对普通肺结核患者卫生服务利用的影响,并评估其在资源配置与成本控制方面的效用。方法:基于Andersen模型,利用河北省某市的临床及医保数据,采用OLS回归和倾向评分匹配(PSM)方法,对5 656例患者的门诊与住院服务利用情况进行实证分析。结果:改革后患者门诊次数和门诊费用平均增加了约4.809次和266.368元(P<0.001)；住院次数、住院费用和医疗总费用分别下降约0.302次、3 638.647元和3 372.279元(P<0.001)。结论:捆绑整合支付模式能有效促进门诊服务利用、优化住院资源分配并降低医疗费用,但其急剧增加的门诊负荷可能带来过度医疗风险。建议:应构建动态监测与评估体系,重点关注门诊与住院服务质量和临床效果；完善激励与约束机制,确保支付改革在实现成本控制的同时保障医疗质量和患者安全。 |
| 关键词:医疗保险支付 捆绑整合支付 卫生服务利用 支付方式改革 |
| 基金项目:国家自然科学基金项目(72071042； 71671039) |
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| “Outpatient+inpatient” bundled integrated payment on the utilization of health services for ordinary tuberculosis patients: An empirical analysis based on a city in Hebei Province |
| XU Peng-yu, YAO Yao, ZHAO Lin-du |
| School of Economics and Management, Southeast University, Nanjing Jiangsu 211189, China |
| Abstract:Objective:To examine the impact of the“outpatient + inpatient” bundled integrated payment reform on the utilization of health services for patients with ordinary tuberculosis, and to evaluate its effectiveness in resource allocation and cost containment.Methods:Based on the Andersen model, clinical and health insurance data from a city in Hebei Province were analyzed.An empirical study was conducted on 5 656 patients using Ordinary Least Squares (OLS) regression and Propensity Score Matching (PSM) to assess outpatient and inpatient service utilization and related costs.Results:Patients in the post-reform group showed a significant increase in outpatient visits and outpatient costs (an average increase of approximately 4.809 visits and 266.368 yuan, respectively, P<0.001), while inpatient visits, inpatient costs, and total medical costs significantly decreased (reductions of approximately 0.302 visits, 3 638.647 yuan, and 3 372.279 yuan, respectively, P<0.001).Conclusion:The bundled integrated payment model effectively promotes outpatient service utilization, optimizes inpatient resource allocation, and reduces medical costs.However, the sharp increase in outpatient workload may pose a risk of overutilization.Recommendations:Future initiatives should establish a dynamic monitoring and evaluation system that emphasizes both service quality and clinical outcomes in outpatient and inpatient settings.Furthermore, refining incentive and regulatory mechanisms is essential to ensure that cost control measures do not compromise medical quality and patient safety. |
| Key words:Medical reimbursement Bundled integrated payment Health service utilization Payment reform |
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