医疗保险预付制改革可以控制我国医疗费用的上涨吗?——基于PSM模型及CHARLS数据的实证分析  

Can prepayment reform of medical insurance control the rise of medical expenses in China? Empirical analysis based on PSM model and CHARLS data

作　　者：鲍震宇 BAO Zhen-yu(Inner Mongolia University of Finance and Economics, Hohhot Inner Mongolia 010070, China)

机构地区：[1]内蒙古财经大学财政税务学院,内蒙古呼和浩特010070

出　　处：《中国卫生政策研究》2017年第9期22-31,共10页Chinese Journal of Health Policy

基　　金：内蒙古自治区高等学校科学研究项目(NJSY17146)

摘　　要：在当前我国医疗服务价格不断上涨,居民就医负担仍然较重的背景下,改革医疗保险支付方式被认为是解决看病贵问题的重要抓手。评估医疗保险预付制改革对控制医疗费用及减轻疾病经济负担的成效具有重要现实意义。本文使用2011年和2015年CHARLS数据,借鉴DIDPSM思想,运用交互项模型与PSM模型相结合的分析方法,利用2012年新农合预付制支付方式由试点改革阶段进入全面普及阶段的一次自然实验,研究发现:(1)预付制可以控制门诊及住院费用上涨,即与改革初期未参保者相比,全面普及预付制改革后参保患者的门诊和住院费用均有所下降;(2)预付制改革后,参保患者的门诊和住院自付费用分别下降了17%和33%,说明医疗保险及其预付制改革一定程度上抵御了医疗费用的上涨,减轻了居民就医负担;(3)在PSM的基础上,交互项模型系数的估计值和显著性未发生改变,印证预付制改革效果良好。At present, China＇s medical service costs keep rising, and residents＇ out-of-pocket medical expenses are also increasing heavily. The prepayment reform of medical insurance is considered as an important starting point to solve the problem. It is of great significance to evaluate the effect of prepaid medical insurance reform on con- trolling medical expenses and reducing economic burden when sick. In order to achieve the objective of this study, a use of CHARLS data 2011 ＆ 2015 and DIDPSM theory, and a combination of the Interaction Item Model and PSM model, and make use of a natural experiment developed from experimental reform stage for the comprehensive promo- tion stage of new rural cooperative medical system （NCMS） in 2012, were very crucial. This paper finds that： （ 1 ） Prepayment system can control the rise in outpatient and inpatient expenses. Compared with those who did not participate in NCMS in the initial stage of reform, after the universal reform, outpatient and inpatient expenses dropped by 6.3 % and 41%, the average decrease was 1041yuan and 2895yuan, respectively. （2） After the universal reform, the insured patients＇ medical burden of outpatient and inpatient reduced by 17% and 33%. Prepayment system has, to some extent, resisted the rise in medical expense, and alleviated the burden of medical treatment. （3） On the basis of PSM, the estimated value and significance of coefficients have not changed, the effect of PPS reform is good. The policy implication is that accelerating the prepayment system reform is the key way to control the growing medical expenses.

关 键 词：预付制 供方道德风险 医疗费用上涨 PSM 

分 类 号：R197[医药卫生—卫生事业管理]