通讯作者: 小娟, zhangxjzhang@163.com

DOI：10.12201/bmr.202302.00013

Utilization, cost and risk analysis of outpatient medical services among insured persons of basic medical insurance

• 摘要：目的：分析45岁以上人群门诊服务利用、费用和风险。方法：基于CHARLS2018年数据,分别进行单因素分析和多元logit回归。结果：门诊服务利用率明显低于自行购药,门诊费用和自行购药费用月均1000元以上组占比最高,门诊和购药费用获得医保报销的比例明显低于住院,报销比例亦是如此。门诊保障水平对门诊费用利用影响有统计学意义；门诊利用和自行购药都是引致灾难性卫生支出的重要影响因素；随着慢病患者种数的增加,未住院患者发生灾难性卫生支出的风险增加。建议：完善基本医保门诊报销政策,引导患者合理利用医疗服务,提高基金支出效率；重新认识门诊费用,重构医保待遇保障组合；提高慢病患者的门诊保障水平,减轻慢病患者门诊费用风险。

  关键词： 门诊服务利用; 门诊费用; 灾难性卫生支出

   

  Abstract: Objective: To analyze the utilization, cost and risk of outpatient services among people over 45 years old. Methods: Based on CHARLS 2018 data, univariate analysis and multivariate logit regression were performed respectively. Results: The utilization rate of outpatient services was significantly lower than that of self-purchasing medicines. The group with an average monthly average of more than 1,000 yuan for outpatient and self-purchasing medicines accounted for the highest proportion. The level of outpatient security has a statistically significant impact on the utilization of outpatient expenses; outpatient utilization and self-purchasing of medicines are both important factors that lead to catastrophic health expenditures; with the increase in the number of chronic disease patients, the number of catastrophic health expenditures for non-hospitalized patients increases. Risk increases. Recommendations: Improve the basic medical insurance outpatient reimbursement policy, guide patients to rationally use medical services, and improve the efficiency of fund expenditure; re-understand outpatient expenses, and reconstruct the medical insurance treatment and security portfolio; improve the outpatient insurance level of chronic disease patients, and reduce the risk of outpatient expenses for chronic disease patients.

  Key words: outpatient service utilization; outpatient cost; catastrophic health expenditure

  提交时间：2023-02-28

  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。
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• 序号	提交日期	编号	操作
  1	2022-10-10	bmr.202302.00013V1	下载

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