摘要
提升医疗保障和医疗服务水平对扎实推进共同富裕具有重要意义。基于中国健康与养老追踪调查2011—2018年3期数据,研究不同地区人群间、城乡人群间、不同收入人群间参保状态、住院服务利用、住院家庭经济负担的差异及动态趋势,结果显示:基本医疗保险未参保率逐年降低,但东北地区、城市、高收入人群的未参保率较高;未参保和居民医保的参保者在地市级以上医院就诊的比例逐年扩大,就诊模式呈“重心上移”的趋势;住院自付住院费用和家庭经济负担呈增长趋势。回归分析结果表明:未参保、东北地区、最低1/3收入和农村人群的住院服务利用水平更低,住院家庭经济负担更重;与在县市级以下机构就诊的患者相比,在地市级以上医院就诊患者的自付住院费用较高,家庭经济负担更重。基于此,建议进一步深化改革,建立未参保人群精准识别和扩面机制,提升医保的统筹层级,深化供方医保结算制度改革,以提高医保支付效率,促进社会公平,推动共同富裕。
Improving the level of medical security and medical service is of great significance to promoting common prosperity.Based on the data of the China Health and Retirement Longitudinal Study(CHARLS)from 2011 to 2018,this study examines the differences and dynamic trends of insurance status,inpatient services utilization,and financial burden among the people in different regions,with different urban and rural status,and with different income level.The results show that the uninsured rate of basic medical insurance decreases year by year,but the uninsured rate is higher in northeast China,cities,and high-income groups.The proportion of the uninsured and participants in the medical insurance for urban and rural residents seeking treatment at the hospitals above city-level has been steadily increasing year by year,indicating a shift-up trend of"focus"in the treatment patterns.The results of regression analysis show that the group uninsured,the group in the northeast,the group with the lowest third of income,and the group in rural areas have lower level of inpatient services utilization and their families undertake heavier financial burden.Compared with patients treated at the hospitals below the county-level,patients treated at the hospitals above city-level have higher out-of-pocket expense and heavier family financial burden.Based on this,it is suggested to further deepen the reform by establishing a mechanism of the accurate identification and expansion of coverage,updating the overall coordination level of medical insurance,and reforming the settlement system for healthcare providers,so as to improve the efficiency of medical insurance payments,promote social equity,and advance common prosperity.
作者
高月霞
郭芳琪
GAO Yuexia;GUO Fangqi
出处
《社会保障研究》
CSSCI
北大核心
2024年第4期18-30,共13页
Social Security Studies
基金
国家社科基金重大项目“以深化改革促进全体人民共同富裕研究”(项目编号:22ZDA030)的阶段性成果。
关键词
医疗保险
未参保
住院服务
家庭经济负担
地市级以上医院
共同富裕
medical insurance
the uninsured
inpatients’service
household financial burden
the hospitals above city-lev
common prosperity
