摘要
本文采用国务院城镇居民基本医疗保险评估入户调查数据,构建医疗服务利用对预期价格敏感性差异的面板门槛模型,发现我国灾难性医疗支出标准应为家庭年度医疗服务自负金额占收入的44.13%;继续建立处理效应模型实证检验灾难性医疗支出的微观作用机理,结果表明:家庭发生灾难性医疗支出后,个人收入将降低0.1163个百分点,个人健康将降低7.9947个单位,个人医疗服务支出将增加0.6344个百分点;基于现行大病保险实践经验提出三种大病保险补偿方案,均可显著降低我国灾难性医疗支出发生率,但从降低幅度和平稳性两个方面比较,以家庭为补偿对象、以家庭灾难性医疗支出作为补偿标准的评估方案则明显优于其他两个方案。
To further enhance security levels and reduce the economic burden of catastrophic health expenditure, China＇s government issued The Guidance Policy to Carry Out Critical Illness Insurance Program in 2012. This policy identifies the standard of catastrophic health expenditure according to disposable income per capita, but does not design reimbursement modes in detail according to each insured＇s economic condition and heahhcare cost level. Based on household and individual micro data （ Urban Residents Basic Medical Insurance Survey 2007--2011 ） , we explore the catastrophic health expenditure standard and analyze the mechanism behind the multi-level medical security system that reduces catastrophic health expenditure, which in turn affects the use of medical services. We also evaluate the effects of different reimbursement modes to reduce the medical burden and the incidence of catastrophic health expenditure. This study makes three main contributions. First, based on Grossman （1972） , we introduce the catastrophic health expenditure budget constraints, and conclude that the sensitivity of medical demands differs from the sensitivity of medical service prices. Without the catastrophic health expenditure, medical service price elasticity is less than 1, while with the catastrophic health expenditure, it is elasticity greater than 1. In empirical analysis, using the panel threshold regression method, we find that when the household annual out-of-pocket medical expenditure accounts for about 44.13% of income, the individual medical service price elasticity changes as previously described. Hence, we conclude that this value should be China＇s catastrophic health expenditure standard. Second, in empirical analysis, we indicate that catastrophic health expenditure not only is the comprehensive result of the current income, health status, and medical cost, but also has long-term effects on the future, causing a new round of catastrophic health expenditure. Therefore, the results of the treatment effect mod
作者
朱铭来
于新亮
王美娇
熊先军
ZHU Minglai YU Xinliang WANG Meijiao XIONG Xianjun(School of Finance, Nankai University Collaborative Innovation Center for China Economy School of Insurance, Shandong University of Finance and Economics National School of Development at Peking University China Health Insurance Research Association)
出处
《经济研究》
CSSCI
北大核心
2017年第9期133-149,共17页
Economic Research Journal
基金
国家自然科学基金(批准号:11301303)
国家社会科学基金项目(批准号:15BJY007)
中国保险学会教保人身保险高校课题研究基金(批准号:jiaobao2017-07)
泰山学者工程专项经费(批准号:tsqn20161041)资助
山东省高等学校优势学科人才团队"机器学习与大数据分析团队(批准号:1716009)"的资助
关键词
灾难性医疗支出
大病保险
医疗服务利用
多层次医疗保障
Catastrophic Health Expenditure
Critical Illness Insurance
Health Care Utilization
Multi-level Medical System
