关键词: 城乡居民医保, 门诊统筹, 就医分流, 健康保障

Abstract: At present, the over-all planning for the outpatients has become an inevitable trend in the development of medical insurance for urban and rural residents. The design of the over-all planning for outpatients system is expected to achieve the effect of medical triage and protect the health of residents.This paperinvestigates the triage effect and health effect of the over-all planning for outpatient model in different provinces by selecting the data of CHARLS in 2015 and 2018 and adopting the main characteristic variable model and the ordered multiple-choice PROBIT modelrespectively. The empirical findings show that the over-all planning foroutpatients system limited at the grass-roots level has achieved medical triage, while the over-all planning foroutpatients system not limited at the grass-roots level has hindered the triage of medical treatment, but it has no statistical significance.Compared with the over-all planning for outpatients limited at the grass-roots level, the over-all planning for outpatients not limited at the grass-roots level can better improve the health level of residents. The result of the study of the age groups show thatover-all planning for outpatients limited at thegrass-roots level can achieve better medical triage effect for urban residents aged 45-60, while the over-all planning for outpatients not limited at the grass-roots level may promote the gathering of urban and rural residents over the age of 60 to higher-level medical institutions.The over-all planning for outpatients can promote the health perception of rural residents over the age of 60 regardless of whether it is limited or not limited to the grass-roots level, and the over-all planning for outpatients not limited to grass-roots level can better promote the health level of rural residents aged 45-60. According to the problems revealed from the empirical study, it is recommended to improve the level of outpatient security at the grass-roots level and improve the reform of the health supporting system to help the triage effect and the health security effects of the over-all planning for outpatients.

Key words: urban and rural residents' medical insurance;, over-all planning for outpatients, medical treatment triage, health security