关键词: 门诊统筹, 就医选择, 门诊住院, 资源配置

Abstract: The reform of outpatient coordination of the medical insurance plays a key role in optimizing the order of patients’ medical care and guiding the functional positioning of hospitals. This study adopts thedistrict and county data of the urban and rural residents’ health insurance outpatient coordination from 2008 to 2021 in 21 prefectural cities and states in Sichuan Province and matches them to the local mesoscopic data in the Wind Database to empirically test the impact of the outpatient coordination reform on the residents’ choice of medical treatment and the treatment behaviors of the medical institutions with the progressive double-difference method. The findings show that the outpatient coordination reform has reduced the proportion of hospital consultations and admissions by 1.3% and 1.8% respectively, while the proportion of the consultations and admissions in the primary health care institutions has increased by 1.4% and 1.8% respectively. The reform has led to a 2.4% increase in the rate of inpatient surgery in public hospitals, while the number of bed days and the bed utilization rate have dropped significantly, and the outpatient coordination has led to a further reorganization of the functions of public hospitals. It is recommended that the allocation of primary medical care resources be further strengthened, that public hospitals be monitored for their treatment practices, and that the experience of building close-knit medical communities be promoted as soon as possible.

Key words: outpatient coordination, medical selection, outpatient hospitalization, resource allocation