道德风险还是医疗需求释放?——医疗保险与医疗费用增长  

Moral Hazard or Release of Medical Demand?——Medical Insurance and Growing Medical Costs

作　　者：谢明明[1] 王美娇[1] 熊先军[2] 

机构地区：[1]南开大学金融学院,天津300350 [2]中国医疗保险研究会,北京100716

出　　处：《保险研究》2016年第1期102-112,共11页Insurance Studies

基　　金：教育部人文社会科学重点研究基地重大项目"我国社会发展与民生保障战略研究"(编号13JJD840004)和教育部哲学社会科学研究重大课题攻关项目"老龄化对中国经济发展的影响及应对策略研究"(编号13JZD005)的资助

摘　　要：本文利用“中国城镇居民基本医疗保险评估入户调查”2007～2011年微观数据，采用Ⅳ Probit模型、Treatment处理效应模型考察了医疗保险的事前道德风险和事后道德风险，结果表明：医疗保险事前道德风险并不存在，人们在有医疗保险之后并不会增加不健康行为的概率；另一方面，在自负医疗支出占家庭收入的比例低于40％时，自负医疗支出对生活支出没有挤出，医疗保险对医疗费用的显著促进作用更多的是事后道德风险因素而非医疗需求的释放，而在40％以上时医疗保险保障水平不足，没有观察到道德风险问题。因此，在医疗保障水平有限的情况下，政策关注点更多的应该是提高保障水平使医疗需求合理释放而非减少道德风险的激励机制，未来随着保障水平的提升，道德风险会逐渐成为主要问题。Based on the individual data from Urban Resident Basic Medical Insurance Annual Survey, this paper employed IV Probit and Treatment models to empirically study the ex-ante moral hazard and ex-post moral hazard in medical insurance. The results of the study are as follows ： there is no ex-ante moral hazard in medical insurance, for people do not increase the probability of unhealthy behaviors after purchase of medical insurance ; in addition, when medical spending accounts for less than 40% of household income, medical expenditure doesn＇ t squeeze out living expenses;the significant promotion of medical insurance on medical expenses is more a moral hazard than the release of medical needs;when the ratio is higher than 40%, there is insufficient medical insurance protection and no moral hazard is detected. To conclude, in the current situation of limited medical insurance level in China, the policy focus should be put on improving the protection level so as to release medical demands, rather than on redncing the incentive mechanism of moral hazard. With the improvement of the level of medical protection, moral hazard will gradually become a major problem.

关 键 词：道德风险 医疗需求释放 医疗费用增长 

分 类 号：F840.684[经济管理—保险]