医疗保障水平的福利效果  

The Welfare Effect of Medical Insurance

作　　者：赵绍阳[1] 臧文斌[2] 尹庆双[3] 

机构地区：[1]四川大学经济学院,610065 [2]西南财经大学公共管理学院,610074 [3]西南财经大学

出　　处：《经济研究》2015年第8期130-145,共16页Economic Research Journal

基　　金：国家自然科学基金青年项目(71303167);四川大学中央高校基本科研业务费项目(skqy201521);西南财经大学中央高校基本科研业务费项目的资助

摘　　要：本文通过建立社会福利最大化的理论模型,将最优医疗保障水平表示为几个充分统计量的函数形式,然后利用我国某城市城乡基本医疗保险制度改革提供的"自然实验",实证评估当前医疗保障水平是否达到最优。在考察了连续参保者的住院报销情况,并控制了逆向选择效应之后的实证结果发现,在较低的报销水平时(相当于新型农村合作医疗保险的报销比例),提高保障程度会提升参保居民住院服务利用率,而在较高的报销水平时(相当于城镇居民医疗保险的报销比例),提高保障程度并不会显著提升参保居民住院服务利用率;另外,医保报销比例的提高对总的医疗费用没有显著影响,但是显著降低了患者的自付费用。最后,综合估计得到医疗服务需求的价格弹性和风险厌恶系数等参数。充分统计量的结果显示,新型农村合作医疗保险与城镇居民医疗保险的报销比例可能要低于社会福利最大化的医疗保障水平。在全民医保已实现的前提下,本文的研究结果为进一步提高医疗保障水平提供了初步的实证依据。By constructing an individual utility and social welfare maximization model, we show that the optimal health insurance reimbursement rate can be expressed as a function of several sufficient statistics. We then could evaluate whether China＇s current Urban Resident Basic Medical Insurance or URBMI and New Rural Basic Medical Insurance or NRBMI have reached the optimal reimbursement rate using a city level dataset collected from a ＂natural experiment＂. Our empirical analysis shows that the utilization of inpatient services will increase with the level of reimbursement rate if the reimbursement rate is relatively low, however, the utilization will remain unchanged if the rate is relatively high. Interestingly, we find that total medical expenditure will not be affected significantly by the increase in current reimbursement rate of that city, however, patient＇s out-of-pocket expenditure will decrease. Finally, using the parameters estimated from the empirical models, our results show that the reimbursement rate of both URBMI and NRBMI is lower than the optimal level.

关 键 词：医疗保障 医疗服务需求 道德风险 双重差分 充分统计量 

分 类 号：R197.1[医药卫生—卫生事业管理]