摘要
本文利用样本地区医疗保险微观报销数据,运用双重差分模型检验了门诊统筹对农村中老年人医疗行为的影响。研究表明:(1)门诊统筹后,农村中老年人可避免、不合理的住院行为显著减少,使得住院次数和费用分别降低了17.84%和6.21%;(2)普通门诊的报销水平相对较低,因此门诊统筹尚未改变这一群体对门诊慢性病保障项目的利用程度;(3)在总体层面上,尽管政策使得门诊费用显著提高,但是对住院服务利用产生了显著的负向溢出效应,再加之住院服务相对昂贵,从而既降低了农村中老年人的医疗负担,同时也缓解了医保基金的支出压力。本文的研究为全民医保基本实现背景下,如何进一步优化与完善医保制度的待遇体系,以更好地保障农村中老年人的医疗需求和促进健康提供了有益启示。
With the urban and rural resident basic medical insurance reimbursement data from the sample area,the paper employs the difference-in-difference technique to analyze the impact of establishing a financing scheme for outpatient care on the medical behaviors of rural middle-aged and elderly people.The results show that,first,the avoidable and unreasonable inpatient behaviors reduced significantly after the policy change,which make the utilization and expenditure of inpatient care decrease by 17.83%and 6.21%respectively.Second,the reimbursement level for general outpatient care was relatively low,so this policy change did not affect the utilization of chronic disease coverage for this group.Third,on the whole,after the policy change,the outpatient expenses significantly increased,but it had significant negative spillover effects on the utilization of inpatient care.In addition,inpatient care is relatively expensive,so total medical expenditure significantly decreased,which not only reduces the medical burden of the insured,but also relieves the payment pressure on the medical insurance fund.The study provides useful enlightenment for the improvement of medical benefits so as to provide better health security for the rural middle-aged and elderly people after universal medical insurance coverage has been basically achieved in China.
作者
何文
申曙光
HE Wen;SHEN Shuguang
出处
《农业技术经济》
CSSCI
北大核心
2022年第9期74-87,共14页
Journal of Agrotechnical Economics
基金
国家社会科学基金重大项目“积极老龄化的公共政策与法治问题研究”(编号:19ZDA158)。
关键词
门诊统筹
农村中老年人
医疗行为
慢性病
溢出效应
Establishing a financing scheme for outpatient care
Rural middle-aged and elderly people
Medical behaviors
Chronic diseases
Spillover effects
