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目的:探究新型农村合作医疗的钟摆效应对医疗卫生服务利用的影响程度。方法:利用东部某地2008—2014年新型农村合作医疗报表的数据,分析参合情况、人均诊疗人次、实际补偿费用及实际补偿比的变化情况,在区县层面采用固定效应模型估计门诊、住院服务的人均费用和人均诊疗人次的钟摆效应系数。结果:农业人口参合比例呈先下降后上升的趋势,人均诊疗人次和实际补偿费用整体呈上升趋势,门诊和住院的实际补偿比分别在50%和35%左右波动。门诊人均费用和诊疗人次的钟摆效应系数为0.790和0.936,住院服务对应的系数分别为0.551和0.456。结论:门诊和住院服务均存在钟摆效应,政府在提升新型农村合作医疗保障水平的同时,要考虑钟摆效应对医疗保险基金风险的影响。此外,还应该考虑门诊和住院服务钟摆效应的差异和替代性,适当提高门诊服务的保障水平。
Objective: To explore the effect of pendulum effect of new rural cooperative medical service on the utilization of medical and health services. Methods: Based on the data of new rural cooperative medical reports from 2008 to 2014 in a certain place in the east of China, we analyzed the changes of participation, per capita consultation, actual compensation and actual compensation ratio, and used the fixed effect model to estimate outpatient and inpatient services Per capita costs and per capita clinics pendulum effect coefficient. Results: The proportion of participants in agricultural population tended to drop first and then increase. The average number of people per patient and the actual compensation expenses increased. The actual compensation rates for outpatient visits and hospitalizations fluctuated between 50% and 35% respectively. The pendulum effect coefficient of outpatient per capita expenses and attendance were 0.790 and 0.936, and the corresponding coefficients of hospital services were 0.551 and 0.456 respectively. Conclusion: The pendulum effect exists in both outpatient and inpatient services. While improving the level of new rural cooperative medical insurance, the government should consider the impact of the pendulum effect on the risk of the medical insurance fund. In addition, we should also consider the differences and substitutability of the pendulum effect of outpatient and inpatient services, and appropriately raise the level of protection for outpatient services.