摘要
不同社会医疗保险覆盖的居民在医疗服务及费用方面存在较大差距是我国医疗资源配置不平衡的突出表现。本文利用详尽的住院患者与医疗机构匹配的微观数据,分析了城镇职工基本医疗保险(城职保)和城乡居民基本医疗保险(城乡保)患者花费的差别,及其受疾病种类异质性的影响。在控制疾病种类、患者个人特征和医疗机构等基本特征后,回归结果显示城职保患者的医疗总花费平均显著高于城乡保患者的医疗总花费。用于测量疾病种类异质性程度的疾病总花费变异系数(CV)每增加一个单位,花费差别会增加6.6%—12.8%。其中药品费和检查费在不同保险患者之间的差别受疾病种类异质性的影响较大,而相对固定的诊疗费用差异受到的影响较小。总体而言,疾病种类的异质性会导致医院对不同保险患者收取不同的医疗费用,异质性越大的疾病医疗费用差别就越大。因此,政府应加快推动社会医疗保险支付方式改革,加大监督药品使用和检查项目的力度,从而使医疗资源的配置更加有效。
The Chinese government has expedited healthcare sector reforms over the last two decades.National healthcare expenditures and the total number of beneficiaries of social medical insurance programs have both grown dramatically.National healthcare expenditures reached 5 trillion RMB,6.2%of China's GDP,by the end of 2017.Over 95%of the country's population is covered by one of two social medical insurance programs:Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance(URBMI).The rapid growth in health care expenditures has resulted in considerable financial pressure for both central and local governments.It has therefore become increasingly important for researchers and policy makers to have a comprehensive understanding of the effects of different medical insurance programs on health expenditures.In this paper,we empirically analyze whether the differences in expenditures between enrollees of UEBMI and URBMI are caused by the type of insurance program they are enrolled in and the degree of heterogeneity of diseases they were treated for.We do this using a detailed micro-level data set of patients and hospitals from the city of Chengdu.UEBMI is a mandatory program that covers people who are currently employed or retired employees.URBMI is a voluntary program that covers the unemployed population,including children and students.Both programs are administered at the city level.They mainly cover inpatient expenses and some chronic conditions.The reimbursement method largely takes the form of a traditional fee for service;however,the two programs'reimbursement rates are very different.The nominal reimbursement rate is 85%for UEBMI enrollees and only 50%-65%for URBMI participants if they are treated in tertiary hospitals in the city.Numerous studies examine the impact of medical insurance programs on patients'expenditures and induced demand in China.Far fewer studies analyze the differential impact of UEBMI and URBMI on medical expenditures and induced demand.Our paper makes three contrib
作者
臧文斌
陈晨
赵绍阳
ZANG Wenbin;CHEN Chen;ZHAO Shaoyang(School of Insurance,Southwest University of Finance and Economics;School of Public Administration,Southwest University of Finance and Economics;School of Economics,Sichuan University)
出处
《经济研究》
CSSCI
北大核心
2020年第12期64-79,共16页
Economic Research Journal
基金
国家自然科学基金面上项目“老年人医疗保障、医疗支出与储蓄问题研究(71773080)”
中央高校基本科研业务费专项资金“社会医疗保险和价格歧视——基于成都市住院患者的微观数据研究(JBK2002012)”的资助。
关键词
医疗保险
诱导需求
医保支付方式
Social Medical Insurance
Induced Demand
Payment Method of Medical Insurance
