Research On Patients’ Behavioral Choice Under The Hierarchical Diagnosis And Treatment Policy

With the continuous improvement of living standards,people’s demand for high-quality health services is growing.Under the strategic goal of "Healthy China",the problem of how to establish a medical service system with high quality,high efficiency,low cost and high accessibility is getting more and more attention.At present,China’s medical resources allocation is unreasonable,the basic medical service capacity is insufficient,some patients disorderly medical treatment and other problems are more prominent,the implementation of hierarchical diagnosis and treatment policy has become an important measure to deepen the reform of the medical and health system,promote the equalization of basic medical services.In order to establish a medical treatment pattern of primary treatment,two-way referral,treatment of urgent and slow,and linkage between upper and lower levels,the hierarchical diagnosis and treatment mode is being explored all over the country,but its implementation effect is not obvious.The key to the implementation of the hierarchical diagnosis and treatment policy is how to guide patients to the primary medical institutions.Due to the "freedom" of patients’ choice of medical treatment in China and the information asymmetry between doctors and patients,patients can only make the choice through the grade of the hospital.At this point,the key is to see whether the patients value the price or the quality of medical treatment more,which mainly depends on the residents’ sensitivity to the price and the severity of the disease.In view of this,this paper further classifies the reasons for patients’ choice of medical behavior under the hierarchical diagnosis and treatment policy.Based on the China Family Panel Studies(CFPS)data from 2012,2014,2016 and 2018,this study used the panel regression model to evaluate the implementation effect of the hierarchical diagnosis and treatment policy in terms of the cost of treatment and patient selection,and analyzed the heterogeneity between urban and rural patients and patients with more severe disease.The empirical results show that the hierarchical diagnosis and treatment policy has no significant effect on guiding patients to primary medical institutions and reducing residents’ medical costs.The impact of income on patients’ medical treatment choice is significantly different between urban and rural areas,and residents value the latter more than the medical service quality.However,the change of rural residents’ income has a greater impact on their choice of medical treatment than that of urban residents,and is more sensitive to the price of medical service,and medical insurance policy has a greater guiding effect on rural residents.Especially when the patient’s disease is more serious,this result is more confirmed.As long as urban residents can afford it,they will choose to go to high-quality hospitals.At this time,the hierarchical diagnosis and treatment policy is ineffective.Therefore,in order to promote the smooth implementation of the hierarchical diagnosis and treatment policy,it is necessary to strengthen the construction of primary medical institutions,improve their medical service capacity and quality,formulate differentiated medical insurance reimbursement policies for urban and rural areas,and no longer implement the hierarchical diagnosis and treatment policy restrictions for urban patients with more serious diseases.