人口年龄变化、医疗需求行为与医疗费用增长:基于医疗保险结算数据的实证研究  

The Effect of Age and Health Care Needs on the Growth of Medical Expenditures:Based on the Empirical Research on Medical Insurance Settlement Data

作　　者：李乐乐[1] 杜天天 Li Lele;Du Tiantian(School of public policy and management,Tsinghua University,Beijing 100084,China;Institute for hospital management,Tsinghua University,Shenzhen 518055,China)

机构地区：[1]清华大学公共管理学院,北京100084 [2]清华大学医院管理研究院,广东深圳518055

出　　处：《当代经济管理》2021年第4期72-80,共9页Contemporary Economic Management

基　　金：国家社会科学基金重大项目《医保费用分配及监控的大数据研究》(14ZDB149)。

摘　　要：人口老龄化背景下,医疗费用不断增长,但是年龄对医疗费用增长的影响长期存在争议。利用四川省成都市城镇职工医疗保险的超大样本数据,采用OLS和分位数回归的方法,基于医疗需求行为的视角将影响医疗费用增长的因素划分为先决因素、供给因素、需求因素和能促因素,研究人口年龄变化对医疗费用增长的影响。研究发现:人口年龄变化对医疗总费用增长具有显著的正向影响,人口年龄变化对医疗总费用的影响总体上呈现先升高后降低的“倒U型”变化特征。人口年龄变化对医疗总费用的影响并不是随着年龄的增加,医疗总费用也一直增加。大约59岁是医疗总费用增长高峰的岁数,约47—63岁是医疗总费用增长最快的年龄区间,约71岁后到临近死亡时还会有医疗总费用的快速增长,但是这个增长的幅度不会超过47—63岁的这个医疗总费用增长高峰区间。人口年龄变化对药品费用和检查费用的增长具有显著的正向影响,年龄对药品费用的影响是先降低再升高的“正U型”变化特征,年龄对检查费用增长的影响是一直持续降低变化特征,这说明随着年龄的增加,对检查费用增长的影响在降低。医院等级、报销比例、起付线、住院天数和疾病类型等因素对医疗费用的增长具有显著的影响,但是对不同类型的医疗费用增长具有不同的影响方向和程度。最后,就解决人口老龄化背景下年龄对医疗费用增长的影响提出几点政策启示。Under the context of aging population,medical expenditures are increasing,but the effect of age on the growth of medical expenditures has been controversial for a long time.Based on the great capacity sample data from Urban Employee Basic Medical Insurance(UEBMI)enrollment records of Chengdu,Sichuan province,in order to study the influence of age on the growth of medical expenditures,this paper,using OLS and quantile regression model,divides the factors that affect the growth of medical expenditures into predisposing factors,supply factors,demand factors and enabling factors from the perspective of health services demand behavior.The results show that:Age has a significantly positive impact on the growth of total medical expenditures,and the impact of age generally presents an“inverted u-shape”with going up first and then going down.The medical expenditure does not increase with age all the time.The age of 59 is approximately the peak age for the growth of total medical expenditures;and the age from 47 to 63 is approximately the range for the fastest growth of total medical expenditure;there will be another rapid increase of total medical expenditures from the age of 71 to death,but the increase margin does not exceed that of the peak range between the age of 47 and 63.Age has a significantly positive impact on the growth of drug expenses and examination expenses;the effect of age on drug expenses presents a“U”shape that goes down first and then goes up;the effect of age on examination expenses is continuing to reduce which means that the effect is falling with the increase of age.Factors such as hospital level,reimbursement ratio,deductible,days in hospital and disease type have significant influence on the growth of medical expenditures,but the directions and degrees of effect on the growth of different types of medical expenses are different.Finally,this paper proposes some policy implications to address the impact of age on the increase of medical expenditures under the background of aging population.

关 键 词：人口老龄化 年龄增长 医疗费用 医疗需求 临近死亡 

分 类 号：C913.6[经济管理] F840.684[社会学]