健康卫生融资约束、公共卫生冲击与医疗服务利用——基于SARS疫情的实证研究  

Health Financing Constraints,Public Health Impact and Medical Service Utilization:An Empirical Study Based on SARS Pandemic Situation

作　　者：于新亮 张文瑞 李倩 伊扬 Yu Xinliang;Zhang Wenrui;Li Qian;Yi Yang(School of Insurance,Shandong University of Finance and Economics;Management College,Ocean University of China;School of Economics,Shandong University of Finance and Economics)

机构地区：[1]山东财经大学保险学院,山东济南250014 [2]中国海洋大学管理学院,山东青岛266100 [3]山东财经大学经济学院,山东济南250014

出　　处：《经济科学》2021年第6期143-156,共14页Economic Science

基　　金：国家自然科学基金青年科学基金项目“灾难性卫生支出风险识别、致贫路径与精准保障研究”(项目编号:71804090);山东省社会科学规划研究专项“精准扶贫视角下医养健康保障机制优化与路径选择”(项目编号:19CQXJ08);山东省泰山学者工程专项经费“保险风险优化控制策略研究”(项目编号:tsqn20161041)的阶段性成果。

摘　　要：本文利用2003年SARS疫情在全国蔓延这一典型公共卫生冲击事件,选用地市级SARS疫情病例报告与城镇住户调查数据,建立连续性双重差分的Tobit模型系统检验了公共卫生冲击对家庭医疗服务利用的影响。结果发现:公共卫生冲击显著降低了家庭医疗服务利用,对医疗服务利用较少的家庭和卫生融资约束较高的地区产生了更高的剥夺,从而加深了医疗服务利用集中程度。在系统内部,公共卫生冲击主要通过挤兑医疗资源、降低家庭收入水平、加剧心理恐慌与提升个人防护等路径减少了家庭医疗服务利用,且受到医疗保险调节,即医疗保险覆盖家庭受公共卫生冲击的影响更强烈。研究表明,如果有限的健康卫生资源在公共卫生与医疗服务之间发生结构性扭曲配置,将导致公共卫生冲击下医疗服务健康绩效的恶化,影响社会经济长远发展。Based on the typical public health event of SARS pandemic that rages throughout China in 2003,this paper establishes a continuous DID Tobit model to test the public health impact on the utilization of family medical services using SARS case reports and urban household survey.The results show that the public health impact significantly reduces the utilization of family medical services,especially for families with less medical services utilization and districts with higher health financing constraints,thus aggravating the concentration of medical service utilization.Within the system,the public health impact mainly reduces the utilization of family medical services through crowding out medical resources,reducing family income level,aggravating psychological panic,and increasing channels of personal protection.Public health is also regulated by medical insurance,that is,the families covered by medical insurance are more strongly affected by public health impact.We find that if the limited health resources are structurally distorted in the allocation between public health and medical services,health performance of medical services will be deteriorated under the public health impact,thus affecting the long-term development of social economy.

关 键 词：健康卫生融资约束 公共卫生冲击 医疗服务利用 连续性双重差分 

分 类 号：F126[经济管理—世界经济]