Faculty

基层首诊政策对患者就医选择和医疗费用的影响
  • 基层首诊是分级诊疗的关键环节,对构建有序就医路径和控制医疗费用具有重要意义。本文使用医保结算数据,采用断点回归-双重差分法研究基层首诊政策对患者就医选择和医疗费用的影响。研究发现,基层首诊政策显著降低了61~64岁参保人首诊选择三级医院的概率和对应的疗程总费用,但没有改变未退休群体的首诊选择。机制分析表明,该政策通过扩大基层首诊与越级首诊间医保待遇差距、增加时间成本影响患者选择。此外,政策实施后61~64岁参保人更多流向二级医院而非基层机构,基层机构服务能力较弱是阻碍患者向下就医的主要原因。本文研究结论表明,基层首诊政策仅能改变部分老年患者,尤其是慢性病患者的首诊选择,没有改变未退休群体向上就医的偏好,仅从需方成本分担角度推进分级诊疗的效果较为有限。

Barriers and Facilitators for Stroke Patients’ Adherence to Rehabilitation in China: A Qualitative Study Based on Medical Experts

Research Field: Stroke is a neurological condition characterized by prolonged rehabilitation, requiring long-term patient cooperation for effective recovery. Rehabilitation adherence plays an important role in the prognosis. This study aimed to identify the patient-, doctor-, hospital-, and society-level factors influencing rehabilitation adherence. In this qualitative study, semi-structured interviews were conducted with 25 experts in rehabilitation medicine, cardiovascular medicine, and neurology from six representative cities in China (Beijing, Tianjin, Shanghai, Wuhan, Harbin, and Chengdu) to explore the factors affecting rehabilitation adherence. Transcripts were coded and analyzed using an inductive thematic approach for data analysis. NVivo 14 was used to manage and analyze the textual data. All methods were performed in accordance with relevant guidelines and regulations, specifically the Guidelines for the “Prevention and Treatment of Cerebrovascular Diseases (2024 Edition)” and the “2024 China Stroke Prevention and Treatment Guidelines” issued by the General Office of the National Health Commission of the People’s Republic of China. Regarding in-hospital rehabilitation, medical experts believed that the characteristics of patients who had a stroke directly affected their rehabilitation adherence, including rehabilitation expectations, self-efficacy, economic pressure, family support, and trust in doctors. Additionally, medical experts also believed that various factors at the doctor, hospital, and societal levels influence patient characteristics, such as doctors’ professional skills, collaboration between departments, and social cognition, ultimately affecting rehabilitation adherence. For out-of-hospital rehabilitation, medical experts believed that the key determinants of adherence include accessibility to tele-rehabilitation, tele-medical resources, and active participation of hospital outpatient clinics. Most medical experts believed that it is crucial to focus not only on direct factors, such as rehabilitation expectations and self-efficacy, which influence patients’ subjective intentions, but also on identifying the pathways through which doctors, hospitals, and societal factors impact patient behavior. Attention should be given to in- and out-of-hospital rehabilitation.