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目的:研究门诊服务对住院服务的影响,据此提出管理高血压患者医疗卫生服务的政策建议。方法:通过对北京市新型农村合作医疗高血压患者2008—2013年的报销数据进行描述性统计分析和面板固定效应回归分析,统计分析采用两部模型(Two-Part model)。结果:两部模型第一部研究高血压患者总体人群,发现门诊次数、门诊总费用、门诊自付费用和门诊报销费用每增加1.0%分别降低住院率为3.9%,2.8%,1.4%和1.5%,门诊与住院率存在替代效应;第二部研究高血压患者住院人群,门诊服务对住院服务各项指标的边际效应非常小。结论:卫生决策者应该重视门诊服务对住院率的替代作用,加大门诊服务的范围和补充,以降低总体人群的住院率、住院次数和住院费用。对于已经住院的高血压人群,门诊服务对住院服务的影响并不存在经济学上显著性。
Objective: To study the impact of outpatient service on inpatient services, and to put forward policy recommendations for the management of medical and health services for hypertensive patients. Methods: Through the descriptive statistical analysis and the panel fixed effect regression analysis of reimbursement data of hypertension patients in Beijing New Rural Cooperative Medical System from 2008 to 2013, the two-part model was used for statistical analysis. RESULTS: The first study of the two models studied the overall population of hypertensive patients and found that outpatient visits, outpatient costs, outpatient out-of-pocket expenses, and outpatient reimbursement expenses decreased by 3.9%, 2.8%, 1.4% and 1.5% for each additional 1.0% %, Outpatient and hospitalization rate there is a substitution effect; the second study of hospitalized hypertensive patients, outpatient services on the marginal effects of various indicators of hospital services is very small. Conclusions: Health policymakers should value the alternative role of outpatient services in hospitalization and increase the scope and complement of outpatient services to reduce overall hospitalization, hospitalization and hospitalization costs. The impact of outpatient services on inpatient services is not economically significant for those who are already hospitalized.