健康冲击:现行医疗保险制度究竟发挥了什么作用?  

Health Shock: What did Current Health Insurance System Do?

作　　者：周钦[1] 刘国恩[1] 

机构地区：[1]北京大学国家发展研究院

出　　处：《经济评论》2014年第6期78-90,共13页Economic Review

基　　金：中国博士后科学基金面上资助项目(项目编号:2014M560830);"国务院城镇居民基本医疗保险试点评估入户调查"横向课题;美国纽约中华医学基金会(China Medical Board)资助项目的支持

摘　　要：在进一步深化医疗改革的行动中,人们关注的焦点问题是,现行医疗保险制度在应对居民遭遇疾病冲击时究竟发挥了多大作用?本文利用大型微观数据研究了医疗保险制度对居民住院医疗服务利用和经济负担的影响。研究结果显示,医疗保险人群的住院可及性明显高于非医保人群,同时医药总费用也明显较高。然而医保人群的自付医药费用仍然显著低于非医保人群,自付医药费用占家庭年收入的比重也更低。医疗保险制度对减轻老年人群和慢性病人群的医疗经济负担具有显著作用。公费医疗和城职保在降低医疗负担上的作用明显高于其他保险形式。由此得到的基本结论是,现行医疗保险制度提高了医保人群的医疗服务利用水平,显著减轻了其医疗经济负担,并且更多惠及了慢性病、老年人群;未来制度的完善需要重点考虑如何惠及低收入和外地户口人群。What is the role of the current health insurance policy when residents face health shock under the background of health insurance system reform？ Using large survey data, we explore the effects of health insurance on residents＇ health service utilization and financial burden when they suffered serious disease. This paper finds that residents who are covered by health insurance are more likely to use health services than the uninsured residents. In the meantime, out -of- pocket payments of the insured residents are significantly lower than the uninsured, and their ratio of out - of- pocket payment to total year income is also lower than the uninsured. Second, the health insurance coverage improves the access to care for the chronic and old population. Residents with Public Health Insurance （PHI） have the largest drop in economic burden, and those with Urban Employee Basic Medical Insurance （UEBMI） have the second largest effect. In sum, health insurance significantly improves the utilization of health service and reduces the medical financial burden of Chinese residents, especially for the old and the chronic population, but policy makers should pay more attention to low- income residents and migrants.

关 键 词：医疗保险 自付医药费用 医疗经济负担 医疗服务利用 

分 类 号：F842.6[经济管理—保险]