“全民医保”与“垫支”负担——医保垫付制度对居民医疗服务利用的影响  

“Universal Health Insurance”and“Later Reimbursement”Burden:—The Effect of the Later Reimbursement Policy on Residents' Healthcare Utilization

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,北京100080

出　　处：《保险研究》2015年第7期106-119,共14页Insurance Studies

基　　金：中国博士后科学基金面上资助项目(2014M560830);国家自然科学基金项目(71073003);"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：医保垫付制度设计下,参保人群需要先行垫付全额医疗费用,无疑带给个人或家庭垫付医疗费的经济压力。本文从理论和实证的角度就医保垫付制度对居民医疗服务利用的影响进行了研究。理论分析得出,当面临信贷约束和预算约束时,穷人无法获得足够的资金支付医疗费用时,实际的医疗消费将低于最优消费水平。实证部分利用中国健康与养老追踪调查(CHARLS)数据,发现医保垫付人群的健康状况有更差的倾向,但是其住院医药总费用比实时结算人群低12.7%;医保垫付导致低收入和农村参保人群分别缩减64.2%和23.1%的住院医药支出。因此,医保垫付制度给经济水平有限的参保人群造成了明显的垫支压力,进而抑制其医疗需求,这样的制度设计将严重影响医保制度的实际受益人群。Under the later reimbursement system, residents need to pay for the medical expenses in advance, which undoubtedly poses a financial burden on individuals or families. Using basic economics theory and nationally representative data, we aimed to estimate the effect of different reimbursement policies on the utilization and accessibility of healthcare services in China. The theoretical model indicated that the medical consumption of the low income group would be less than the optimal consumption level if there was a credit constraint or a budget constraint. On the empirical part, using data from the China Health and Retirement Longitudinal Study （CHARLS）, we found that although reimbursement policy did not play a significant role in the accessibility of inpatient services, the total inpa- tient expenditure was 12.7% less than that of participants with immediate reimbursement. Subsample analysis dem- onstrated that among the low-income and rural populations, the later reimbursement policy reduced their total inpatient expenditure by 64.2% and 23.1% respectively. Therefore, the later reimbursement policy creates a conspicuous ＂later reimbursement burden＂ on those who are financially constrained, and in turn, depresses their reasonable healthcare demand. Thus the reimbursement system design will seriously affect the beneficiaries of China healthcare reform.

关 键 词：医保垫付制度 医疗服务利用 信贷约束 医疗保障 

分 类 号：F840.684[经济管理—保险]