基本医疗保障制度的“钟摆效应”:基于东部某地新型农村合作医疗的实证分析  

“Pendulum Effect” of the Essential Medical Insurance System: Empirical Case Study Based on the New Rural Cooperation Medical System in an Eastern Region of China

作　　者：刘国峰[1] 孙美平[1] 简伟研[1] 

机构地区：[1]北京大学公共卫生学院,北京100191

出　　处：《中国卫生经济》2016年第6期33-35,共3页Chinese Health Economics

摘　　要：目的:探究新型农村合作医疗的钟摆效应对医疗卫生服务利用的影响程度。方法:利用东部某地2008—2014年新型农村合作医疗报表的数据,分析参合情况、人均诊疗人次、实际补偿费用及实际补偿比的变化情况,在区县层面采用固定效应模型估计门诊、住院服务的人均费用和人均诊疗人次的钟摆效应系数。结果:农业人口参合比例呈先下降后上升的趋势,人均诊疗人次和实际补偿费用整体呈上升趋势,门诊和住院的实际补偿比分别在50%和35%左右波动。门诊人均费用和诊疗人次的钟摆效应系数为0.790和0.936,住院服务对应的系数分别为0.551和0.456。结论:门诊和住院服务均存在钟摆效应,政府在提升新型农村合作医疗保障水平的同时,要考虑钟摆效应对医疗保险基金风险的影响。此外,还应该考虑门诊和住院服务钟摆效应的差异和替代性,适当提高门诊服务的保障水平。Objective：To study the influence on health service utilization caused by pendulum effect under New Rural Coopera-tion Medical System（NCMS）.Methods：Using NCMS statistical report data（2008-2014） at one site in Eastern China to analyze thechanges of participation level, per capita clinic visits, actual reimbursement expense and actual reimbursement rate over time.Fixed-effect model at district＇s/county＇s level was used to explore the pendulum effect of per capita cost for outpatient and inpatientservices and per capita clinic visits.Results：Participation level of agricultural population decreased and then showed a rising tenden-cy. Both per capita clinic visits and actual reimbursement expenses had overall upward trends. Actual reimbursement rates of outpa-tient and inpatient services fluctuated at 50% and 35% respectively. The pendulum effect of per capita costs and per capita outpa-tient visit for outpatient service were 0.790 and 0.936 respectively while inpatient service coefficients were 0.551 and 0.456.Conclusion：Pendulum effect existed in outpatient and inpatient services. Government should consider pendulum effect＇s impact on the riskmanagement of medical insurance fund when improving insurance level of NCMS. Meanwhile, the difference of pendulum effect andsubstitution effect between outpatient and inpatient service should be taken into consideration. The security level of outpatient servicecould be given priority.

关 键 词：新型农村合作医疗 钟摆效应 门诊 住院 医疗保险基金 

分 类 号：R197.1[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学] F323.89[经济管理—保险]