通讯作者: 毛宗福, zfmao@whu.edu.cn

DOI：10.12201/bmr.202108.00026

Analysis of the effect of the new health poverty alleviation“985”policy implementation in Hubei Province：Evidence from four counties in Xianning City

• 摘要：目的 探究湖北省新健康扶贫“985”政策的实施影响，为后扶贫时代调整医疗救助制度提供科学依据和政策建议。方法 使用咸宁市所有4个县2018年7月至2020年9月月度建档立卡农村贫困人口（简称“农村贫困人口”）住院报销数据，应用间断时间序列分析方法，从救助支出、就医行为和救助效果三个维度分析医疗救助制度运行情况的变化。结果 政策实施后，医疗救助总支出显著减少；农村贫困人口在三级医疗机构、二级医疗机构就诊人次占比显著减小，在一级及以下医疗机构、县域内医疗机构、县域内医疗机构或指定转诊医疗机构就诊人次占比显著增加；农村贫困人口人均实际负担费用显著减少，灾难性医疗卫生支出发生人数占比显著下降。结论 新健康扶贫“985”政策节省了救助支出，规范了农村贫困人口就医行为，改善了救助效果。下一步应该科学设定医疗救助标准、适度拓展救助对象，同时规范救助管理体制，提高县域内基层医疗卫生服务水平，进一步优化医疗救助制度。

  关键词： 健康扶贫政策; 医疗救助; 间断时间序列分析; 实施效果

   

  Abstract: Objective To evaluate the implementation effects of the new health poverty alleviation “985” policy in Hubei Province and provide evidence for medical assistance policy making in the post-poverty alleviation era. Methods Collecting monthly hospital services reimbursement data of the rural poor in all four counties of Xianning from July 2018 to September 2020, Interrupted Time Series (ITS) analysis was adopted to analyze the changes in the operation of the medical assistance system from the three dimensions of assistance expenditure, medical treatment behaviors and assistance impact. Results The overall expenditure for medical assistance significantly decreased (β2=-975.393，p<0.01); the proportion of the rural poor who seek healthcare services in tertiary (β2=-861.340, p<0.001) or secondary (β2=-1876.833, p<0.01) health care facilities significantly decreased. On the other hand the proportion of assistance recipients significantly increased at primary level or below (β2=2744.779，p<0.01), in healthcare centers within the county (β2=922.877, p<0.001), or in the referred/recommended designated hospitals (β2=352.407, p<0.001); the individual expense per hospitalized patients significantly decreased (β2=-641.710，p<0.01), and the proportion of catastrophic health care expenditures occurring among the rural poor significantly decreased (β2=-5798.328, p<0.001). Conclusion The expenditure for medical assistance was saved, the medical treatment behaviors of the rural poor were standardized, and the effect of the medical assistance system was improved after the implementation of the new health poverty alleviation “985” policy in Hubei province. We should set the standard of medical assistance scientifically and expand the recipients of aid appropriately, while standardizing the medical assistance management, improving the primary medical and health services in counties to further optimize the medical assistance system.

  Key words: Health poverty alleviation policy; Medical assistance; Interrupted Time Series analysis; Implementation effect

  提交时间：2021-12-21

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• 序号	提交日期	编号	操作
  1	2021-08-16	bmr.202108.00026V1	下载

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