The Impact of the Outpatient Mutual-Aid System on the Medical-seeking Pattern and Cost Burden of Retired and Employed Workers

Wang Jiayi; Yang Jingyu

Abstract：Objective:To explore the different impacts of the Outpatient Mutual-Aid Security(OMAS)system on the medical-seeking pattern and cost burden of retired and employed workers.Methods:Based on the outpatient chronic and special disease settlement data of employees'basic medical insurance in Lanzhou from January 2020 to March 2025,a two-group interrupted time-series model was used to assess the effect of the policy in terms of three dimensions:hierarchical diagnosis and treatment,cost burden reduction,and release of the demand for medical care.Results:After the implementation of the OMAS policy,the average monthly decrease in the grade of medical institutions visited by retired workers was 0.003 grade(P＜0.05),the average monthly decline in the amount of cash payment was 0.71 yuan(P＜0.05),and the average monthly increase in the number of visits to medical institutions was 25.40(P＜0.05);the average monthly increase in the number of visits to medical institutions for employed workers was 5.66(P＜0.05).The changes in the grade of medical institutions visited,and the amount of cash payment were insignificant(P＞0.05).Conclusion:The OMAS policy has begun to show results in promoting hierarchical diagnosis and treatment,reducing the cost burden and releasing the demand for medical care,with retired workers being the greater beneficiaries of the reform.In the future,it is necessary to further refine the existing policy and optimize the policy implementation mechanism to consolidate the effectiveness of the reform.