摘要
《关于开展城乡居民大病保险工作的指导意见》实施以来,各地政府不断加大对城乡居民大病医疗保险的投入,但是城乡居民医疗负担差距不但没有下降反而不断扩大。为解释这种现象背后的逻辑,从理论和实证两个维度系统分析地方政府大病医疗保险筹资竞争对城乡居民医疗负担差距的影响。结果表明:城乡居民大病医疗保险赔付占家庭医疗负担比差距越大,地方政府大病医疗保险筹资竞争越会扩大城乡居民医疗负担差距;另一方面,地方政府大病医疗保险筹资竞争能够提高大病医疗服务供给效率,城乡居民大病医疗支出贴现预期呈上升趋势。由于农村居民医疗保障水平较低和医疗服务需求较大,该调节效应对农村居民大病医疗支出贴现预期影响较大,因此缩小了城乡居民医疗负担差距。鉴于此,建议建立与地区经济发展同步且独立的大病医疗保险筹资体系和地区间城乡居民大病医疗保险筹资协调机制。
Since the implementation of Guiding Opinions on the Implementation of Major Disease Medical Insurance for Urban and Rural Residents,various regions have continuously increased their investment on major medical insurance for urban and rural residents.However,instead of being narrowed,the gap between urban and rural medical burdens has been widened.To explain the logic behind this phenomenon,based on the Grossman’s human capital model of the demand for health and Barrow expenditure model,this article constructs a function of the gap between urban and rural medical burdens that includes major medical expenses,and uses a spatial panel Tobit model to systematically analyze the impact of local competition for major medical insurance funding on the gap between urban and rural medical burdens from two dimensions of theory and empirical evidence.The research findings show that the funding and actual reimbursement ratios of major medical insurance in neighboring areas are positively correlated with the medical burden ratio of urban and rural residents in representative areas,indicating that the increase in funding and reimbursement ratios of major medical insurance in neighboring areas will widen the gap between urban and rural medical burdens in the local area.The larger the gap is between the ratios of major medical insurance compensation to household medical burden between urban and rural residents,the more the competition for local major medical insurance funding will widen the medical burden gap.On the other hand,the efficiency of major medical insurance in neighboring areas is significantly negatively correlated with the medical burden ratio of urban and rural residents in representative areas,indicating that local competition for major medical insurance funding can improve the efficiency of providing medical services for major illness,and the expected discount of medical expenses for major illness of urban and rural residents will increase.However,due to a lower level of medical security for rural residents and a
作者
李涛
朱贺文
张一童
LI Tao;ZHU Hewen;ZHANG Yitong(School of Economics,Qingdao University,Qingdao 266071,China;School of Economics,Ocean University of China,Qingdao 266100,China)
出处
《重庆理工大学学报（社会科学）》
2023年第4期86-101,共16页
Journal of Chongqing University of Technology（Social Science）
基金
国家自然科学基金青年项目“标尺竞争下居民基本医疗保险筹资行为机理、传导机制与优化路径研究”(71904094)
中国博士后科学基金面上项目“环境目标约束下地方政府居民医疗保险策略性筹资行为及传导效应研究”(2021M700413)。
关键词
城乡居民
医疗负担
大病医疗保险
财政竞争
筹资均等化效应
urban and rural residents
medical burdens
major disease medical insurance
financial competition
equalization effect of financing
