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目的:考察湖南省常德市城镇居民基本医疗保险住院付费方式改革的成效,包括按人头付费与开放式首诊改革政策。方法:利用城镇居民基本医疗保险入户调查的面板数据,采用普通最小二乘法(OLS)、有序Probit等方法。结果:主要有3个结果,(1)按人头付费及开放式首诊改革政策显著降低了住院患者自付费用以及平均住院日;(2)总住院费用和患者满意度并没有显著变化;(3)稳定性检验的结果表明,基于自评健康较差人群的回归结果与基于全样本的结果类似。结论:常德的按人头付费及其配套政策减轻了患者的经济负担、缩短了住院时间,但是并未降低总医疗费用,同时也没有降低患者的满意度。
OBJECTIVE: To investigate the effectiveness of the reform of hospitalization payment for urban resident basic medical insurance in Changde, Hunan Province, including payment by head to head and the reform of open first consultation. Methods: Using the panel data of urban residents’ basic medical insurance in-home survey, the methods of ordinary least squares (OLS) and ordered Probit were used. Results: There were three main results: (1) the policy of head-pay and open-first reform significantly reduced the out-of-hospital expenses and average length of stay; (2) there was no significant change in total hospitalization and patient satisfaction; ( 3) The results of the stability test showed that the regression results based on self-rated poor health were similar to those based on the full sample. Conclusion: The headcount payment and its supporting policies in Changde have reduced the financial burden on patients and shortened the length of hospital stay, but did not reduce the total medical treatment costs and did not reduce patient satisfaction.