【摘要】 目的 分析异地就医直接结算政策实施前后，天津市和河北省（以下简称“津冀”）居民到北京市三级公立医院住院服务利用的现状，探讨异地住院费用的影响因素，为异地就医直接结算政策的后续实施和优化提供科学依据。方法 基于2016—2022年北京市三级公立医院病案首页数据，统计京津冀住院患者人次数，收集患者的人口学资料、疾病特征和医疗保险（以下简称“医保”）类型、次均住院总费用，用以比较地区间住院服务利用及费用差异。结果 北京市三级公立医院的异地就医患者中，津冀患者人次占比由2016年的26.13%上升至2022年的28.71%;40～69岁患者占比70.04%，职工医保占比36.61%;26.09%进行放化疗、术后康复等治疗或操作，20%以上在外科住院。津冀患者观察期内的次均费用为28 489.6元，比北京本地患者高出约20.67%(β=0.188,P<0.01)。结论 异地就医政策推动了津冀患者赴京就医规模持续增长，且人群结构和疾病谱系呈现鲜明特征——以40～69岁劳动年龄人口为主，职工医保参保者占比较高，诊疗行为显著集中于外科手术、放化疗及术后康复等高资源消耗领域。与之相应，津冀患者的次均住院费用显著高于北京本地患者。建议从推进区域诊疗协同、优化高龄老人就医服务、强化医保基金差异化支付等方面完善政策，提升异地就医体系的公平性和可持续性。更多还原

【Abstract】 Objective This study attempts to analyze the utilization of inpatient services by residents from Tianjin and Hebei seeking care at tertiary public hospitals in Beijing before and after the implementation of the direct settlement policy for cross-regional medical care, to explore the influencing factors of cross-regional hospitalization costs, and to provide scientific evidence for the subsequent implementation and optimization of this policy. Methods Data were extracted from the medical record face sheets of tertiary public hospitals in Beijing between 2016 and 2022. The number of inpatients from Beijing, Tianjin, and Hebei was calculated, and data on their demographics, disease characteristics, medical insurance types, and average cost per hospitalization were collected. A fixed-effects log-linear regression model was used to analyze factors influencing medical costs. Results Among cross-regional patients in Beijing’s tertiary public hospitals, the proportion of patients from Tianjin and Hebei increased from 26.13% in 2016 to 28.71% in 2022. Patients aged 40–69 accounted for 70.04%, and those covered by Employee Basic Medical Insurance accounted for 36.61%. 26.09% underwent treatments or procedures such as radiotherapy, chemotherapy, and postoperative rehabilitation, and over 20% were hospitalized in surgical departments. During the observation period, the average cost per hospitalization for patients from Tianjin and Hebei was 28 489.6 yuan, which was approximately 20.67% higher than that for local Beijing patients(β = 0.188, P<0.01). Conclusions The cross-regional healthcare policy has facilitated the sustained growth in the number of patients from Tianjin and Hebei seeking medical care in Beijing. Distinct characteristics were observed in their demographic and disease profiles: predominantly working-age individuals(40–69 years old), with a relatively high proportion of Employee Basic Medical Insurance participants. Their diagnosis and treatment behaviors were significantly concentrated in high-resource consumption areas such as surgeries, radiotherapy, chemotherapy, and postoperative rehabilitation. Correspondingly, the average cost per hospitalization for patients from Tianjin and Hebei was significantly higher than that for local Beijing patients. Therefore, it is recommended to improve policies by promoting regional healthcare coordination, optimizing medical services for the elderly, and strengthening differentiated payment policies of medical insurance funds, to enhance the equity and sustainability of the cross-regional healthcare system.更多还原