医疗需求释放、患者道德风险还是供方诱导需求?——基本医疗保险类型转换后医疗费用上涨的路径研究  

Normal Health Demand,Patient Moral Hazard or Supplier Induced Demand? The Source of Rising Medical Expenditure after the Change of Basic Medical Insurance Type

作　　者：朱铭来 王恩楠 Zhu Minglai;Wang Ennan(School of Finance,Nankai University;Zhou Enlai School of Government,Nankai University)

机构地区：[1]南开大学金融学院,天津300350 [2]南开大学周恩来政府管理学院,天津300350

出　　处：《经济科学》2021年第2期110-122,共13页Economic Science

基　　金：国家社会科学基金项目“职工基本医疗保险个人账户改革研究”(项目编号:18BGL199)的资助。

摘　　要：为分析城乡居民医疗保险合并后不合理医疗开支的增加路径,本文首先以居民的参保类型由新农合转换为城居保作为冲击,建立理论模型并提出研究假设后,利用DID模型得到转换社会基本医疗保险类型使居民的住院和自付医疗费用显著上升的结果。其次,本文以PSM-DID模型排除医疗需求自然释放对医疗支出的影响,进而确定此过程中道德风险的存在。在上述实证分析的基础上,本文结合工具变量方法得到在转换医疗保险类型过程中道德风险来自于医疗机构的结论。进一步地,本文通过居民异质性分析发现,低消费水平和低学历的居民更易受到医疗服务供给方诱导需求的影响。This paper has analyzed the path of existing unreasonable medical cost inflation after the combination of urban and rural social basic medical insurance,which is the key point of controlling and slowing down the growth of medical expenditure. Firstly,this paper establishes the theoretical model based on the change of basic medical insurance type and proposes research hypotheses. Then we apply difference-in-differences( DID) model to explore how the social basic medical insurance type affects the rising medical expenditure. In addition to DID model,we also use the Propensity Score Matching( PSM) model to decrease the difference of sample and show that the growth of health expenditure from moral hazard rather than normal medical demand.Based on the above empirical analysis,we use instrumental variable to verify the moral hazard from the medical service suppliers rather than patients in the process of changing social basic medical insurance. Furthermore,according to the analysis of residents ’ heterogeneity,we find that patients who have low income and education levels are more vulnerable to the supplier induced demand.

关 键 词：整合城乡居民医疗保险 医保类型转换 道德风险 诱导需求 

分 类 号：F062.5[经济管理—政治经济学] F842