Zhang Lu, Wang Zhonghua, Qian Dongfu, Ni Jian
School of Health Policy & Management, Nanjing Medical University, Hanzhong Road 140, Nanjing 210029, Jiangsu Province, P,R China.
BMC Health Serv Res. 2014 Apr 23;14:185. doi: 10.1186/1472-6963-14-185.
Outpatient reimbursement levels of the New Rural Cooperative Medical Scheme have changed in recent years in China, and those changes may have a greater impact on patients with chronic diseases due to their higher outpatient expenses. This study represents the first attempt to identify the effects of reimbursement level on outpatient service utilization for chronic patients in rural China and it also gives strong estimation results by conducting a tracer illness study in order to control for possible biases associated with studying several diseases together.
This study used difference-in-differences models to examine how changes in yearly maximum reimbursement amount and outpatient reimbursement rates affected rural residents with type 2 diabetes in three counties in Jiangsu Province, China. Other factors, such as sex, age and severity of illness, were also included in the model estimations. To make sure the treated group and control group are comparable, Propensity Score Match (PSM) was used to analysis the gender, age and severity of illness of the two groups.
The results indicate that an increase in yearly maximum reimbursement amount for outpatient visits could cause an increase in yearly total outpatient expenses for patients with type 2 diabetes mellitus. However, changes in outpatient reimbursement rates between 2010 and 2011 did not significantly affect the utilization of different types of health institution.
The reimbursement rates of village clinics should be substantially increased from the existing basis and the gap of reimbursement rates among different institutions should be further widened. It is also important for village clinics to improve their services. Moreover, measures to improve the quality of care and scope of services at lower-level healthcare institutions, and promote the health service utilization of rural women should be considered.
近年来，中国新型农村合作医疗的门诊报销水平发生了变化，由于慢性病患者门诊费用较高，这些变化可能对他们产生更大影响。本研究首次尝试确定报销水平对中国农村慢性病患者门诊服务利用的影响，并且通过开展一项追踪疾病研究以控制因同时研究多种疾病可能产生的偏差，从而得出了有力的估计结果。
本研究使用差分模型来检验年度最高报销金额和门诊报销率的变化如何影响中国江苏省三个县的2型糖尿病农村居民。模型估计中还纳入了其他因素，如性别、年龄和疾病严重程度。为确保治疗组和对照组具有可比性，采用倾向得分匹配法（PSM）分析两组的性别、年龄和疾病严重程度。
结果表明，门诊年度最高报销金额的增加可能导致2型糖尿病患者年度门诊总费用增加。然而，2010年至2011年门诊报销率的变化对不同类型医疗机构的利用率没有显著影响。
村卫生室的报销率应在现有基础上大幅提高，并进一步扩大不同机构之间的报销率差距。村卫生室改善其服务也很重要。此外，应考虑采取措施提高基层医疗机构的医疗质量和服务范围，并促进农村女性的卫生服务利用。
