《保险研究》20260208-《门诊慢特病跨省异地就医直接结算与患者就诊行为》（刘双赫、何庆红、王震）

［摘   要］门诊慢特病跨省异地就医直接结算政策的实施关系到患者的切身利益。本文以西部地区W省为例，使用双重差分模型分析了直接结算政策对患者跨省就医意愿和医疗费用的影响。结果表明，政策实施显著提升了患者的跨省就医意愿，增加了单次跨省医疗费用和医保基金支出，但整体上降低了年度总就诊次数和医疗支出。进一步分析发现，政策效应与区域医疗资源质量密切相关，医疗资源质量相对较低的地区跨省就医意愿提升更为显著。此外，不同年龄、性别和病种的患者受政策影响的程度存在显著异质性。本文为进一步完善跨省异地就医政策提供了重要参考。

［关键词］门诊慢特病；跨省异地就医直接结算；双重差分模型

［基金项目］本研究得到中国社会科学院“青启计划”项目“健康公平视角下医疗资源空间可及性评估和优化：兼论异地就医与医联体建设”（2025QQJH47）和中国社会科学院青年人文社会科学研究中心社会调研项目“我国医联体建设的实践探索及其成效分析”（2025QNZX021）的支持。

［作者简介］刘双赫，中国社会科学院大学经济学院博士研究生；何庆红（通讯作者），中国社会科学院经济研究所助理研究员；王震，中国社会科学院经济研究所研究员、中国社会科学院大学教授。

Direct Settlement of Cross-Provincial Off-Site Medical Treatment for Outpatient Chronic and Special Diseases and Patient Behaviors

LIU Shuang-he，HE Qing-hong，WANG Zhen

Abstract：The implementation of the direct settlement of cross-provincial off-site medical treatment for outpatient chronic and special diseases has a direct bearing on the interests of patients.Using the Difference-in-Differences analytical model，and taking Province W in western China as an example，this paper explores on the policy’s impacts on patients’ willingness for seeking cross-provincial medical treatment and their medical expenditure. The results show that the implementation of this policy significantly boosts such willingness，results in an increase in the medical expenditure and payout of the social medical insurance fund on a single trip basis，but brings down the total number of medical visits and medical care expenditure per annum.Further analysis indicates that the policy effect is closely related to the local medical service quality.The willingness for cross-provincial medical treatment is stronger for regions with relatively lower quality medical services.Moreover，there is significant heterogeneity in the policy impacts for patients of different age，gender or with different illness.This paper offers useful insight for further enhancing the cross-provincial off-site medical treatment policy.

Key words：outpatient chronic and special diseases；direct settlement for cross-provincial off-site medical treatment；the Difference-in-Differences Model