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从中国社区居民视角看家庭医生签约公共政策对医疗费用的影响

The impact of public policy of family doctor contracting on medical expenses from the perspective of residents at community level in China.

作者信息

Li Lele, He Xiaotong, Zhang Caihua

机构信息

School of Labor and Human Resources, Renmin University of China, Beijing, China.

School of Politics and Public Administration, Southwest University of Political Science and Law, Chongqing, China.

出版信息

Front Psychol. 2023 Jan 4;13:972904. doi: 10.3389/fpsyg.2022.972904. eCollection 2022.

Abstract

OBJECTIVE

To analyze the impact of the contract of family doctors in community-level in Beijing on residents' medical expenses, so as to explore the efficacy of family physician contract service to facilitate the hierarchical treatment system. This study pioneeringly used the panel data of medical records and medical insurance settlement details provided by a community hospital in Beijing. By analyzing the correlation between family doctors and medical expenses, the study provided empirical support for the advancement of family doctor contracting in China.

METHODS

Using the panel data of medical records and medical insurance settlement details of 5,851 residents in a community hospital in Beijing from January 2018 to May 2021 for a total of 41 months, mixed-effects model and random-effects model were used for analysis.

RESULTS

The contract of family doctor has significantly increased residents' medical expenses. The types of medical insurance and whether patients with chronic diseases have a significant impact on residents' medical expenses.

CONCLUSION

Family doctor contracting increases the probability of residents seeing a doctor in community hospitals. Community family doctor contracting services should be vigorously promoted, especially for special groups such as chronic disease patients and the elderly. The increase in the contracting rate of family doctors will become an important starting point for promoting hierarchical medical system and increasing the primary treatment at the community-level.

摘要

目的

分析北京市社区层面家庭医生签约对居民医疗费用的影响,以探讨家庭医生签约服务对推进分级诊疗制度的成效。本研究开创性地使用了北京某社区医院提供的病历和医保结算明细的面板数据。通过分析家庭医生与医疗费用之间的相关性,为我国推进家庭医生签约提供实证支持。

方法

利用北京某社区医院2018年1月至2021年5月共41个月的5851名居民的病历和医保结算明细的面板数据,采用混合效应模型和随机效应模型进行分析。

结果

家庭医生签约显著增加了居民的医疗费用。医保类型以及慢性病患者是否患有慢性病对居民医疗费用有显著影响。

结论

家庭医生签约提高了居民在社区医院就诊的概率。应大力推广社区家庭医生签约服务,尤其是针对慢性病患者和老年人等特殊群体。家庭医生签约率的提高将成为推进分级医疗制度和增加社区基层首诊的重要切入点。

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