The ordering of social access to health care is a realistic presentation of hierarchical diagnosis and treatment and a focal goal of the Health China strategy. As an important policy tool to guide the health care behavior of the population, there is a lack of sufficient literature to support the actual effectiveness of the medical insurance differentiated compensation policy and whether there are differences in the types of services. Through empirical tests on CHARLS data, the study finds that: the medical insurance differentiated compensation policy has contributed to rationalization of outpatient attendance behavior and has had a limited impact overall; the structural mismatch between the policy-set health insurance reimbursement rates and the goal of ordering social pattern of health care is an important reason for limiting the effectiveness of the medical insurance differentiated compensation; under specific circumstances, the policy effect is subject to the moderating effect of medical service capacity, and the realization of the policy effect also takes into account the extent to which the reimbursement standard of health insurance matches the service capacity of medical institutions. The conclusions of the study provide a reference for the improvement of the differential compensation policy of health insurance and the realisation of the ordering of the social pattern of medical care.

社会就医格局秩序化既是分级诊疗愿景的现实呈现,也是健康中国战略的焦点目标。作为引导居民就医行为的重要政策工具,医保差异化补偿政策的实际效果如何以及是否存在服务类型上的差异还缺乏足够的文献支持。通过对CHARLS数据的实证检验,研究发现:医保差异化补偿政策推动了门诊而非住院就医格局的秩序化,且总体影响程度有限;政策设定的医保补偿标准与社会就医格局秩序化目标的结构性失配是限制政策效果的重要原因;政策对社会就医格局秩序化的推动作用在特定医疗服务类型中受到医疗服务能力的调节作用,政策效果的发挥还应考虑医保补偿标准与医疗机构服务能力的匹配程度。研究结论为医保差异化补偿政策的完善和社会就医格局秩序化的实现提供了参考。