环境污染的代价--饮用水污染对居民医疗费用和医保基金支出的影响  

The Cost of Environmental Pollution:Impact of Drinking Water Pollution on the Medical Expenditure of Residents and Medical Insurance Funds

作　　者：方黎明[1] 郭静 彭宅文[3] Fang Liming;Guo Jing;Peng Zhaiwen(School of Insurance,University of International Business and Economics,Beijing 100029,China;School of Public Health,Peking University,Beijing 100191,China;School of Government,Sun Yat-Sen University,Guangzhou 510275,China)

机构地区：[1]对外经济贸易大学保险学院,北京100029 [2]北京大学公共卫生学院,北京100191 [3]中山大学政治与公共事务管理学院,广东广州510275

出　　处：《财经研究》2019年第12期46-58,共13页Journal of Finance and Economics

基　　金：北京市社会科学基金项目(17YJB011)。

摘　　要：控制过高的不必要的医疗费用对减轻个人、医疗保险基金和公共财政的医疗支出负担具有重要意义。文章基于2014年和2016年中国劳动力动态调查数据,使用两部模型和反事实框架考察了饮用水污染对城乡居民医疗费用和医保基金支出负担的影响,结果发现:(1)饮用水污染提高了城乡居民使用门诊服务和住院服务的概率,并由此增加了门诊和住院费用支出,进而增加了社会医疗保险基金支出;(2)饮用水污染所导致的医疗费用,在门诊费用和住院费用中分别约占10%和7.5%;(3)社会经济地位较低的居民,因饮用水污染导致的医疗支出负担更重,城乡贫困居民因饮用水污染导致的人均门诊费用和住院费用分别相当于非贫困居民的1.46倍和1.34倍;(4)2016年全国城乡居民因饮用水污染所导致的总医疗费用合计约3 400亿元,约占当年全国卫生总费用的7.4%,社会医疗保险基金因为饮用水污染支出约1 500亿元,约占当年医保基金支出的12%。To control medical expenditure is important to residents,medical insurance funds,and public finance. Based on China Labor Force Dynamics Survey in 2014 and 2016 in China,with the methods of the two-part model and the counterfactual framework,the research examines the impact of drinking water pollution on the medical expenditure of residents,and the spending burden of medical insurance funds. The results indicate that:Firstly,drinking water pollution increases the outpatient and inpatient expenditure from residents,which also increases the outpatient and inpatient reimbursement expenditure. Secondly,drinking water pollution contributes almost 10% of the outpatient expenditure and 7.5% of the inpatient expenditure. Thirdly,residents with lower socioeconomic status suffer a heavier burden of medical expenditure due to drinking water pollution;the per capita outpatient expenditure and hospitalization expenditure of poor residents due to drinking water pollution are equivalent to 1.46 times and 1.34 times of non-poor residents,respectively.Fourthly,in 2016,the medical expenditure contributable to drinking water pollution in China is about 340 billion yuan,which is equivalent to 7.4% of the total health expenditure this year,and the reimbursement expenditure from medical insurance funds contributable to drinking water pollution is about 150 billion yuan,accounting for about 12% of the expenditure of medical insurance funds.

关 键 词：水污染 医疗费用 生态文明 

分 类 号：F840.684[经济管理—保险]