垂直整合是否会增加初级保健住院患者的成本? 来自中国国家试点计划的证据
Huawei Tan1, Xueyu Zhang1, Xinyi Peng1
1Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Archives of public health = Archives belges de sante publique
|August 26, 2024
概括
在县级卫生组织的垂直整合 (VI) 显著增加了初级保健住院患者的总和自付医疗支出. 这表明VI可能会加剧不同保险计划医疗保健成本的经济差异.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
背景情况:
- 县级综合卫生组织 (CIHO) 是一项旨在改善医疗保健服务的政策干预.
- 垂直整合 (VI) 是CIHO的关键组成部分,涉及医疗保健服务的整合.
- VI对初级保健住院费用的财务影响仍然是一个需要研究的领域.
研究的目的:
- 评估CIHO内部垂直整合 (VI) 对初级保健住院患者所产生的成本的影响.
- 分析VI实施后的总卫生支出 (THS) 和自有支出 (OOP) 的变化.
主要方法:
- 利用了来自西县的住院患者索赔数据,这是CIHOs的试点站点.
- 员工倾向得分匹配,以创建可比的治疗 (VI) 和控制 (非VI) 组.
- 应用差异分析来评估VI对THS和OOP支出的影响.
主要成果:
- 病毒感染与每例总医疗支出 (THS) (β=0.1337,p<0.01) 和每例自付费用 (OOP) (β=0.1661,p<0.001) 的显著增加有关.
- 在不同类型的保险中观察到THS和OOP支出增加,包括城市/农村居民和雇员的基本医疗保险.
- 影响因领先的医疗分中心而异,与人民医院领导的成本增加相关的成本增加较高.
结论:
- 在初级保健机构的垂直整合显著提高了患者的总和自付费用.
- 这些发现表明,VI有可能扩大不同保险集团之间医疗保健成本负担的现有经济差异.
- 政策干预应考虑VI的财务影响,以减轻潜在的不平等.
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