医疗保险改变了居民的就医行为吗?——来自我国CHNS的证据  

Has Health Insurance System Changed Health Care Seeking Behavior?——Evidence from Chinese CHNS

作　　者：郑莉莉[1] Zheng Lili

机构地区：[1]中央财经大学保险学院

出　　处：《财政研究》2017年第2期84-97,共14页Public Finance Research

基　　金：北京市社会科学基金资助;项目名称<北京市城镇职工基本医疗保险筹资比例与支付方式研究>;编号:16YJC070

摘　　要：居民的就医行为关系到不同层次医疗机构资源的利用效率,关系到我国医药卫生体制改革的效果,还关系到我国居民的整体健康水平。本文构建了居民就医的选择理论模型,根据模型提出研究假设,并利用"中国健康与营养调查数据库(CHNS)"1989-2011年的数据,使用嵌套Logit模型评估医疗保险对居民就医行为的影响。研究发现,医疗保险确实对居民患病时选择就诊起到了正向的作用,在居民选择医疗机构时,基本医疗保险引导居民向社区、乡一级医院就医的措施产生了一定的作用。研究还发现基本医疗保险制度重住院轻门诊的给付结构对就医行为产生了不利的影响。本文的研究为进一步从政策层面优化居民就医行为提供了理论和实证的依据。This paper models individual health care seeking behavior using a choice model, and proposes hypothesizes. Our sample consists of China Health and Nutrition Survey Database during the period of 1989 to 2011. By using Nested Logit Model estimations, our results reveal that health insurance has a significant impact on health care seeking behavior, and the social health insurance has a positive impact on guiding people to lower level medical institutions. This paper also finds that payment structure places particular emphasis on hospital reimbursement, so enrollees are apt to reduce out-patient use and increase out-patient use. Those findings provide a theoretical and empirical basis for further optimization of health care seeking behavior from the policy level.

关 键 词：医疗保险 就医行为 嵌套Logit模型 

分 类 号：F842.6[经济管理—保险]