微观经济个体参保行为对医疗费用支出的影响效应研究  

Study on the Effect of Microeconomic Individual's Insurance Participation on the Control of Medical Expenses

作　　者：张鑫 赵苑达[1] ZHANG Xin;ZHAO Yuanda

机构地区：[1]东北财经大学金融学院,辽宁大连116025

出　　处：《社会保障研究》2020年第2期38-50,共13页Social Security Studies

基　　金：国家哲学社会科学基金“保险公司过度风险承担与系统性风险跨市场传染机制研究”(17BJY204)成果。

摘　　要：本文根据2016年中国家庭追踪调查数据,运用面板数据回归方法和倾向得分匹配法(PSM)研究微观经济个体参保行为对医疗费用支出的影响。研究表明,城镇职工医疗保险参保行为显著提高了医疗总费用和自付费用,城乡居民医疗保险参保行为对降低医疗总费用和自付费用具有一定的积极作用,新农合参保行为显著降低了医疗总费用,对自付费用的降低具有一定的积极作用。运用PSM法解决内生性问题和消除选择性偏差后得到的净效应结果与上述发现基本一致。参保行为与医院等级的交互分析表明,选择社区诊所等基层诊疗机构就诊可显著降低医疗总费用和自付费用,选择综合医院就诊则显著提高医疗总费用和自付费用。此外,参保行为对医疗费用支出的影响具有个体和区域异质性。据此,建议增强基层医疗卫生服务能力,进一步提高统筹层次,推进公共卫生服务均等化。According to 2016 China Family Panel Studies,this paper uses the panel data regression method and propensity score matching method(PSM)to study the influence of microeconomic individual's insurance participation on medical expenses.The research shows as follows:the participation of basic medical insurance for urban employees significantly increases the total medical expenses and out-of-pocket expenses;the participation of basic medical insurance for urban and rural residents has a certain positive effect on reduction of the total medical expenses and out-of-pocket expenses;the participation of the new rural cooperative medical scheme significantly reduces the total medical expenses which has a positive effect on the reduction of out-of-pocket expenses.The net effect of solving endogenous problems and eliminating the selectivity deviation by PSM method is basically consistent with the above findings.The interaction analysis between the insurance participation and the hospital level shows that choosing community clinics and other primary medical institutions can significantly reduce the total medical costs and out-of-pocket costs while choosing general hospitals can significantly increase total medical expense and out-of-pocket expenses.In addition,the effect of insurance participation on medical expenses has individual and regional heterogeneity.Therefore,it is suggested to enhance the ability of basic medical and health services,further upgrade the pooling level,and promote the equalization of public health services.

关 键 词：微观经济个体 医疗保险 医疗费用 内生性 异质性 

分 类 号：R47[医药卫生—护理学]