异地就医与本地就医费用及其结构的差异:基于医保大数据的研究
The Differentials in Medical Expenditures and Their Structure between Cross-Region and Local Medical Treatments:Based on the Research on the Social Medical Insurance Big Data
陈昕欣 1封进 2钱梦岑3
作者信息
- 1. 东北财经大学经济学院
- 2. 复旦大学经济学院
- 3. 复旦大学公共卫生学院
- 折叠
摘要
对异地就医行为的监管,一直是医疗保险管理经办的薄弱环节.本文利用中国西北部某地级市居民医保的住院赔付数据,比较异地就医和本地就医医疗费用的差异,以考察异地就医中是否存在基金使用不合理带来的费用增加.在控制了疾病种类、患者个人特征和医院机构等基本特征后发现,异地就医患者的医疗费用要比本地就医高出44％;从分项费用来看,药费是造成本地和异地住院费用差异的重要因素;实施单病种付费的疾病、治疗方案差异性越小的疾病,异地和本地医疗费用差距越小.本文的结果说明,异地就医中存在"基金管理缺位"带来的医疗支出增加,可为进一步完善异地就医直接结算政策、推进异地就医支付方式改革提供政策参考.
Abstract
The regulatory oversight of cross-region medical treatments remains a persistent vulnerable facet within the framework of the social medical insurance management.Leveraging on the hospitalization claims data from a specific prefecture-level city in northwestern China,this study rigorously investigates differentials in medical expenditures between cross-region and local medical treatments.The primary objective is to discern whether the observed escalation in costs associated with cross-region medical treat-ment is a consequence of irrational fund utilization.After controlling basic characteristics such as disease types,patient character-istics and hospital attributes,our empirical results reveal that medical expenses incurred by cross-region patients surpass those of their locally-treated counterparts by a notable 44％.In terms of itemized expenses,medicine costs are an important contributor to the observed disparity between local and cross-region inpatient expenses.Furthermore,the gap in medical expenditure is smaller for diseases subject to single-disease payment and with smaller differences in treatment methods.Our study suggests that the dis-cerned increase in medical outlays in the context of cross-region medical treatment is attributable to a"lacuna in fund manage-ment".In terms of practical implications,this paper provides policy insights,particularly for refining the direct settlement policy for cross-region medical treatment and promoting the payment method reform for cross-region medical practices.
关键词
异地就医/医疗费用/医保基金Key words
cross-region medical treatment/medical expenses/social medical insurance fund引用本文复制引用
出版年
2024
NETL
NSTL
万方数据