通讯作者: 杨帆, 632682623@qq.com

DOI：10.12201/bmr.202107.00028

Research on the Influence of the Outpatient Security Level’s improvement on Medical Service Utilization and Medical Insurance Fund Expenditure -Based on the case analysis of Sanming City

• 摘要：本文基于福建省三明市政府所公布的公立医院运行、医保基金使用月度报告数据，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状况以及医保基金支出的变化。数据分析结果显示，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。基于上述分析结果，本文提出相应政策建议，包括合理设置不同级别医疗机构间门诊报销支付比例、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; ; ; ; 

   

  Abstract: Based on the monthly report data on the operation of public hospitals and the use of medical insurance funds published by Sanming Municipal Government, this paper analyzes the changes of the utilization of medical services and expenditure of medical insurance funds in Sanming City after the improvement of urban employees’ medical insurance outpatient protection level. The results of data analysis show that after the policy intervention, the outpatient demand of workers medical insurance insured groups in Sanming city was released; There has been a certain degree of substitution between the utilization of inpatient services and outpatient services in the insured groups; The construction of graded diagnosis and treatment order in the region is in good condition; There is no obvious change in the expenditure trend of the employee medical insurance pooling fund. Based on the above analysis results, this paper puts forward corresponding policy suggestions, including setting the proportion of outpatient reimbursement payment among different levels of medical institutions reasonably, improving the supporting policies such as outpatient doctors remuneration and drug supply, and connecting public health with outpatient security policies.

  Key words: Medical insurance for urban employees; Outpatient protection; Reimbursement ratio; Medical services; Medical insurance fund

  提交时间：2021-11-02

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
• html

• 图表

• 张小娟. 基于门诊和住院保障的视角重构医保待遇组合. 2021. doi: 10.12201/bmr.202103.00006

  于凌云, 于梦迪. 城乡居民医保基金运行效率及其影响因素研究. 2021. doi: 10.12201/bmr.202109.00035

  刘孟嘉, 张金穗, 陈文, 胡敏. 定点医疗机构信用管理在医保基金监管中的重要性与实现策略. 2020. doi: 10.12201/bmr.202009.00017

  李 珍, 张 楚. 医保筹资. 2021. doi: 10.12201/bmr.202105.00013

  王延中, 赵东辉. 新制度主义视角下城乡居民大病保险保障效果的影响因素分析. 2021. doi: 10.12201/bmr.202110.00038

  侯艳杰, 王瑜, 颜诗源, 张文静, 张琳, 姚俊. 长期护理保险对中老年人医疗服务利用、医疗负担及健康的影响——基于双重差分法的实证研究. 2021. doi: 10.12201/bmr.202107.00029

  杜倩, 仇雨临. 基层政府创新及扩散研究——以整合城乡居民基本医疗保险政策为例. 2021. doi: 10.12201/bmr.202007.00027

  许光建, 乔羽堃. 我国医疗服务价格调整与医保支付方式改革的联动机制研究. 2021. doi: 10.12201/bmr.202104.00018

  郝倩, 章平. DRG付费模式下医保监管系统设计与实现. 2021. doi: 10.12201/bmr.202108.00018

  周晓媛, 何月, 范少瑜, 张引颖. 基于投入-产出视角的职工医保和居民医保对比分析 —以四川省21个统筹地区为例. 2020. doi: 10.12201/bmr.202007.00020

• 序号	提交日期	编号	操作
  1	2021-07-13	bmr.202107.00028V1	下载

• 公开评论  匿名评论  仅发给作者 提交评论