城乡居民医疗保险中逆向选择效应的检验  

Testing Adverse Selection Effect Related to Medical Insurance

作　　者：钟晓敏 杨六妹 鲁建坤 ZHONG Xiaomin;YANG Liumei;LU Jiankun(Zhejiang University of Finance&Economics,310018;Wuhan University,430072)

机构地区：[1]浙江财经大学财政税务学院 [2]武汉大学财政金融研究中心

出　　处：《财贸经济》2018年第10期118-130,共13页Finance & Trade Economics

基　　金：中宣部文化名家暨"四个一批"人才工程专项经费;浙江财经大学地方财政研究院专项经费的资助

摘　　要：本文基于杭州市某三甲医院真实门诊就诊数据实证分析城乡居民医疗保险中的逆向选择效应。不同于采用问卷调查数据的研究以居民自评等度量个体健康程度,本文构建理论模型推导居民健康状况决定函数并基于真实诊疗数据估算个体健康程度,更为客观、准确。继而,基于OLS、Logit等回归模型,分析参保状态和健康状况之间的关系,检验城乡居民医疗保险中的逆向选择效应。研究发现,在是否参保决策时,存在逆向选择效应,居民健康状况显著地影响参保状态,未参保居民健康状况优于参保居民;但在参保档次决策时,逆向选择效应并不显著。本文的政策启示是,建设城乡统一的医保制度时,或可试行强制参保化解逆向选择问题,并适当增加参保可选档次满足居民多样化需求。This paper empirically analyzes the adverse selection effect about urban and rural medical insurance based on real outpatient visit data from a top-level hospital in Hangzhou.Rather than taking the questionnaire survey data regarding the residents health status self-evaluation,this paper constructs a theoretical model to derive the health status of related residents and then estimates the health status of the residents who cannot be directly observed.Based on the regression models such as OLS and Logit,the relationship between insurance participation and health status was analyzed,and the effect of adverse selection of medical insurance for urban and rural residents was examined.The study found that there is an adverse selection effect about the decision of whether to participate in the insurance policy or not.The health status of the residents significantly affects the willingness of insurance participation.The health status of the uninsured residents is better than the insured.However,in the decision-making stage,the adverse selection effect is not significant.This paper sheds light on policy-making that when building a unified urban and rural medical insurance system,it may be possible to enforce compulsory insurance requirements to resolve the adverse selection problem,and appropriately increase the optional grades of insurance to meet the diverse needs of residents.

关 键 词：效用函数 门诊数据 健康状况分布 逆向选择 

分 类 号：F069.9[经济管理—政治经济学]