医疗保险共付额降低政策对 15 岁以下儿童医疗利用的影响。
Impact of Coinsurance Reduction Policy on Healthcare Utilization Among Children Under 15.
机构信息
Institute of Health Services Research, Yonsei University, Seoul, Korea.
Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea.
出版信息
J Korean Med Sci. 2023 Oct 9;38(39):e309. doi: 10.3346/jkms.2023.38.e309.
BACKGROUND
On October 1, 2017, a new coinsurance reduction policy for children under 15 was introduced to minimize the lack of inpatient medical services for economic reasons and secure children's access to medical care.
METHODS
This study analyzes the effect of this coinsurance reduction policy on healthcare utilization using data from the National Health Insurance Service-National Sample Cohort between 2015 and 2019. Groups were classified by 3 case groups and a control group according to age. The dependent variables were inpatient cost, admission, length of hospitalization, outpatient cost and visit, and total cost. The difference-in-differences method was used to examine changes in healthcare utilization among the case and control groups after policy implementation.
RESULTS
Children of the age group 1-5 exhibited an increase in inpatient services and a decrease in outpatient services. There was a 16.17% increase in inpatient cost, 8.55% increase in inpatient admission, 10.67% increase in inpatient length of hospitalization, -9.14% decline in outpatient cost, and -6.79% decline in outpatient visits. Regarding children in the age groups of 6-10 and 11-15, the effect of the policy was inconclusive.
CONCLUSION
The reduction in coinsurance rate policy in hospitalization among children has increased inpatient services and reduced outpatient services for 1-5-year-olds-a substitute effect was observed in this group. There is need for further research to examine the long-term effects of the coinsurance reduction policy.
背景
2017 年 10 月 1 日，实施了一项新的儿童（15 岁以下）补充保险减免政策，以尽量减少因经济原因导致的儿童住院医疗服务不足，并确保儿童能够获得医疗服务。
方法
本研究使用 2015 年至 2019 年国家健康保险服务-国家样本队列的数据，分析了这一补充保险减免政策对医疗保健利用的影响。根据年龄将人群分为 3 个病例组和 1 个对照组。因变量为住院费用、住院、住院天数、门诊费用和就诊次数、总费用。采用差异中的差异方法，考察了政策实施后病例组和对照组之间医疗保健利用的变化。
结果
1-5 岁儿童的住院服务增加，门诊服务减少。住院费用增加 16.17%，住院人数增加 8.55%，住院天数增加 10.67%，门诊费用减少 9.14%，门诊就诊次数减少 6.79%。对于 6-10 岁和 11-15 岁的儿童，政策的效果不明确。
结论
儿童住院补充保险费率降低政策增加了 1-5 岁儿童的住院服务，减少了门诊服务——该组出现了替代效应。需要进一步研究以检验补充保险减免政策的长期效果。
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