讨论稿：从“医疗挤兑”到“普惠医疗”：武汉疫情防控策略转变的效应分析

1 No. C2020006 2020-12-08 从“医疗挤兑”到“普惠医疗”： 武汉疫情防控策略转变的效应分析 张丹丹 黄金迪 摘要：我国的新冠疫情防控政策取得了举世瞩目的成效，为世界各国的防疫提供了宝贵经验。特别是作为疫情初发地的武汉，在三个月内成功地应对了“医疗挤兑”，实现了新冠患者清零。本文分析了武汉从“医疗挤兑”到“普惠医疗”的抗疫过程，强调了疫情防控策略转变对救治效果的影响，以及在这种转变过程中政府有效管控的重要性。基于武汉一家新冠收治定点医院的诊疗记录，从病死率和愈后恢复情况，分析了基于“应收尽收”的普惠医疗对新冠救治的积极影响。研究发现，相比早期的医疗挤兑阶段，武汉逐渐实现普惠医疗后新冠患者死亡概率明显降低；院内的医疗资源稀缺程度改善（联排氧装置启动、医患比例上升），也显著降低了新冠病死率；危重、高龄患者的病死率对医疗资源获得性更为敏感；此外，经历过医疗挤兑的新冠患者在痊愈后心理健康状况相对较差。本文强调了应对公共卫生危机，为避免挤兑的发生，需政府介入在短期内加强稀缺医疗资源供给的重要性。 关键词：新型冠状病毒疫情、医疗挤兑、病死率、公共卫生政策 本项研究得到国家自然科学基金“面上项目”（项目号：71973004）、国家社会科学基金重点项目（项目批准号 20AZD086）、国家高端智库项目、北京大学“新型冠状病毒感染的肺炎防控攻关专项课题”的资助。作者感谢张明祥、张知、张曼筠提供的数据及武汉调研资助，以及刘朔岑提供的优秀助研工作。 张丹丹，北京大学国家发展研究院，电话：01062759779，电子邮件：ddzhang@nsd.pku.edu.cn，邮寄地址：北京市海淀区颐和园路 5 号北京大学国家发展研究院，100871；黄金迪，北京大学国家发展研究院，电话：01062759779，电子邮件：huangjindi@pku.edu.cn，邮寄地址：北京市海淀区颐和园路 5 号北京大学国家发展研究院，100871。 2 From “Hospital Runs” to “Health Care for All”: The Impact of the Public Health Policy Change Abstract: China’s public health measures during the pandemic have significantly contained the spread of 2019 novel coronavirus (COVID-19). In particular, Wuhan, as the first epicenter, had successfully overcome the problem of hospital runs and achieved its zero newly-confirmed COVID-19 patients in three months, which is a miracle of public health prevention. This paper reviews the whole process of Wuhan's fight against the COVID-19 and divides it into two parts with the first part featured by “hospital runs” and the second part featured by “health care for all”. We emphasizes the impact of the change of public health measure on the treatment outcomes. This paper uses a unique data from a COVID-19 designated hospital in Wuhan to verify the benefical health effect of the “health care for all” policy implemented during the COVID-19 pandemic. Our analysis shows that the COVID-19 mortality rate is significantly higher in the period of hospital runs; the availability of medical resources in the hospital (connected oxygen device, doctor-patient ratio) significantly reduces the in-hospital death and this reduction is more salient for the critically ill or the elderly patients. In addition, we find that going through the period of hospital runs is negatively associated with the mental health status of COVID-19 patients even after discharge. This paper highlights the importance of providing sufficient medical sources by the government to deal with the hospital runs during the public health pandemic. Key Words: COVID-19，Hospital Runs，Mortality，Public Health Policy 3 一、引言 新型冠状病毒肺炎（COVID-19）是全世界仍在共同面对的一场史无前例的公共卫生危机。相比人类历史上的大型流行性传染病，COVID-19 具有传染性强，病死率高的特点。2020 年初，武汉集中爆发。3 月开始，全球其他国家陆续大范围流行。截至 12 月初已波及 218 个国家，确诊人数逾 6500 万①。根据世界卫生组织（WHO）和一些相关研究推算（Pollán et al.，2020；Havers et al.，2020），全球实际感染新冠肺炎人数远高于确诊病例的数量，实际的感染病例可能已经高达 4 亿人。截至 11 月底，COVID-19 的死亡人数已经超过 145 万人，病死率在 2%左右。相比之下，每年导致全球约 29 万至 65 万人死亡的季节性流感病死率仅为 0.01%②。COVID-19 在感染人数以及病死率方面堪称流行病之最。 COVID-19 的这些特点使得其在迅速传播的同