参保机会、保障水平与医疗服务利用均等化——基于广东省A市的地区差异分析  

The Opportunity of Participating in Insurance, Security Level and Equality in Health Care Services: Analysis of Regional Disparity in City A,Guangdong Province

作　　者：瞿婷婷[1] 申曙光[1] 

机构地区：[1]中山大学岭南学院,广东广州510275

出　　处：《财经研究》2013年第7期96-109,共14页Journal of Finance and Economics

基　　金：国家社会科学基金重大项目"新时期中国民生保障体系建设研究"(10zd&038);国家社会科学基金重点项目"中国医疗保障体系的制度整合与可持续发展研究"(09AZD039)

摘　　要：文章基于两部模型,利用从广东省A市城镇职工基本医疗保险信息管理系统中提取的微观数据,考察了参保机会及保障水平对该市三个地区参保人医疗服务利用及其均等化的影响。主要结论是:参保机会均等总体上能促进地区间医疗服务利用均等化,但无法从根本上解决亲富人的医疗服务利用不公平问题;实际报销比例对频率决策阶段的医疗服务利用有显著的正向影响,意味着很可能存在过度医疗,而起付标准对参保人理性就医的约束力有限;特殊病种门诊医疗服务利用在三个地区之间基本实现了均等化,但触发决策阶段的住院医疗服务利用存在地区间不均等,地区间收入水平和住院医疗服务利用率的双重差异是引起这种不均等的主要原因。Based on a two-part model, this paper employs the micro data of insured individuals from the information management system of urban em- ployees＇ social health insurance in city A in Guangdong province to study the effects of the opportunity of participating in insurance and security level on the insured＇s utilization of health care services and the equality among three areas in this city. It arrives at the conclusions as follows, firstly, the equality in the opportunity of participating in insurance overall promotes in- ter-region equality in health care services, but cannot fundamentally solve the unfair pro-rich utilization of health care services; secondly, real reim- bursement ratio has a significantly positive effect on the utilization of health care services at the stage of frequency decision-making, confirming the pos- sible existence of excessive medical treatment, and deductible standard has limited constraints on the insured＇s rational utilization choice; thirdly, the utilization of special diseases outpatient health care services achieves the e- quality among the three regions, but the utilization of inpatient health care services at the stage of contact decision-making does not realize the equality among the three regions, mainly owing to the dual differences in inter-region incomes levels and the utilization rates of inpatient health care services.

关 键 词：医疗服务利用 均等化 地区差异 微观数据 

分 类 号：F840.684[经济管理—保险]