| With the development of multiple factors of society economic transformation such as aging population,expanding urbanization and normalization of population mobility,and the increasing attention to national health status,residents’ concern for their own health and demand for quality medical resources services are growing,and the demand for off-site medical treatment is also growing rapidly.The increase in off-site medical treatment reflects the imbalance between the "double concentration" and "inverted triangle" structure of medical resources in China and the demand for quality medical resources from insured residents.In the context of the multi-faceted reform of the medical system,the regulations,procedures and management of medical treatment in other places are also steadily advancing.In the decade or so since the continuous improvement of off-site medical treatment began in 2009,the tendency of residents’ off-site medical treatment behavior has continued to change,and great breakthroughs have been made in the regulation of off-site medical treatment behavior and its direct settlement policy.Especially in the new round of medical system reform,the country has been pushing to deepen the reform of medical and health system,and the importance of settlement of medical treatment in different places has been increasing.The implementation and promotion of the policy of direct settlement of basic medical insurance for medical treatment in different places has eliminated the process of having to travel between the place of medical treatment and the place of enrollment for reimbursement of medical expenses in the past,facilitating patients’ access to medical treatment in different places,helping them save time and financial costs,and improving the level and efficiency of settlement services for medical treatment in different places.It can be said that the direct settlement method of cross-location medical treatment as a way to adapt to mobility and improve the efficiency of medical treatment satisfies the medical treatment needs of the participants,protects their immediate interests,and has an impact on patients’ medical treatment behavior,orientation and medical costsPatients’ choice and perception of medical treatment are influenced by macro policies,medical resources and personal factors,and are constantly evolving with social progress.In this context,this paper focuses on the group of patients who seek medical treatment in other places.Based on a review of the historical evolution of China’s foreign medical treatment system and the development of direct settlement policy,we analyze the current situation of foreign medical treatment and residents’medical treatment behavior in China,and further explore the influencing mechanism of patients’ foreign medical treatment behavior.On this basis,the factors influencing patients’ off-site medical treatment behavior choice are analyzed by combining three different dimensions influencing patients’ medical treatment behavior in Anderson’s health service utilization model theory,using data from the China Pension and Health Tracking Survey(CHARLS)in 2015 and 2018:constructing a logistic model with medical treatment choice(whether to seek medical treatment off-site)as the explanatory variable,analyzing A logistic model was constructed to analyze the realistic factors influencing the choice of medical treatment,and the regression results of the model were tested for group heterogeneity by gender,place of residence and region.The results showed that self-assessed health level,number of chronic diseases,annual personal income,level of medical institution,transportation distance to medical treatment,reimbursement method,and number of hospitals in the insured area all had significant effects on patients’ choice to seek medical treatment in a different location.Based on the research results,combined with the existing literature and realistic theoretical basis,this paper puts forward countermeasures and suggestions for better promotion of cross-location medical treatment,providing convenient medical services for residents,improving the allocation of primary medical and health resources and strengthening the interface services between large hospitals and primary medical institutions in the context of direct settlement of cross-location medical treatment:(1)unifying and adjusting medical insurance policies:unifying the level of basic medical insurance treatment,reasonably adopting(2)improve the level of medical insurance coordination:actively promote the provincial coordination of basic medical insurance and the transformation of the basic medical insurance participation model;(3)promote the synergy between foreign medical treatment and graded treatment:clarify the positioning of medical institutions’treatment functions,strengthen the capacity of primary medical services and the construction of medical and health care teams;(4)improve the management and operation capacity:improve the referral system for foreign medical treatment,promote information technology,optimize the operation process,and scientifically improve the management and operation capacity.(5)Play the role of "gatekeeper"and regulate the behavior of patients seeking medical treatment in different places:strictly implement the system of reviewing and approving applications for medical treatment in different places,conduct strict examination and approval of applications for medical treatment in different places,build a complete regulatory mechanism for medical treatment in different places,and increase the number of patients seeking medical treatment in different places.We will also strengthen the supervision mechanism and increase the supervision of medical treatment in other places,so as to improve patients’ right to choose and regulate the medical treatment behavior at the same time.The main innovations of this paper are:(1)in terms of research content,the topic of this paper is relatively novel and has certain research significance,and the factors influencing the choice of off-site medical treatment behavior in the context of direct settlement policy are studied and tested at the quantitative level;(2)this paper analyzes residents’ medical treatment behavior in a broad sense based on existing data,thus forming the basis for understanding off-site medical treatment behavior;(3)this study is based on the new public service theory,Anderson health service utilization model and siphon effect theory,combined with the current situation of off-site medical care,the development history and current situation of direct settlement and the current situation of residents’ health and medical care situation,to construct the mechanism and analytical framework of the factors influencing patients’ off-site medical care behavior;(4)using large micro-survey data CHARLS data for empirical analysis,using data from the two-year period of 2015 and 2018 to conduct combined regression analysis,which can significantly enhance the reliability of the model regression results;(5)in terms of research methods,by using the method of logistic model analysis for the analysis of influencing factors,and the group heterogeneity test by gender,place of residence and region as well as the permutation model robustness test for the regression results underlying the empirical study,which further verifies the robustness of the regression results and enhances the empirical results(6)This paper incorporates a variety of influencing factors into the study,and matches the data with the city statistical yearbook,and includes factors such as medical resources(number of hospitals,number of beds per 1,000 people))of the participating places into the theoretical framework of influencing factors for analysis.At the same time,combining the current situation and research results,we propose experiences worthy of learning from the management of off-site medical treatment in China. |
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