医疗保险中的事前道德风险真的存在吗?--基于健康态度和健康行为的系统GMM检验  

Does ex-ante moral hazard in medical insurance really exist:A systematic GMM test based on health attitude and health behaviors

作　　者：王红波 宫佳宁 WANG Hong-bo;GONG Jia-ning(School of Public Administration and Policy,Renmin University of China,Beijing 100872,China;School of Women's Studies,China Women's University,Beijing 100101,China)

机构地区：[1]中国人民大学公共管理学院,北京100872 [2]中华女子学院女性学系,北京100101

出　　处：《中国卫生政策研究》2021年第12期51-59,共9页Chinese Journal of Health Policy

基　　金：中国人民大学2021年度拔尖创新人才培育资助计划成果。

摘　　要：国内外有关事前道德风险在真实医疗保险参保数据中的经验检验结果并不一致,且有关我国基本医疗保险中事前道德风险的实证研究稀少。本文基于个体风险健康行为具有长期稳定性的特征,将个体既往健康行为纳入模型,利用2004-2015年中国健康与营养调查(CHNS)数据构建动态面板模型,并用系统GMM方法来检验基本医保中事前道德风险是否存在。在将预防性活动区分为健康态度和健康行为的前提下发现:不区分医保类型的平均效应显示,参加基本医保会带来健康态度降低的事前道德风险,但并不会带来吸烟和饮酒行为的增加;区分医保类型时,参加职工医保或居民医保都不会带来健康态度弱化、吸烟量或饮酒量增加的事前道德风险。相反,参加职工医保还会显著降低参保人的每月饮酒量,起到改善风险健康行为的作用。文章最后对未来相关研究的重点及医保制度建设提出了建议。Inconsistency exists in the empirical test results of ex-ante moral hazard in China's and foreign real-world medical insurance data.Furthermore,empirical studies were rarely conducted on ex-ante moral hazard in China's basic medical insurance.Based on the fact that the risk health behaviors of individuals have long-term stability,this paper used a model to describe past health behaviors of individuals,constructed a dynamic panel model by using the data from 2004 to 2015 Chinese Health and Nutrition Statistics(CHNS),and used systematic GMM method to test whether ex-ante moral hazard exists in China's basic medical insurance.On the premise of dividing preventive activities into health attitude and health behaviors,this paper found that:as shown by the average effect without distinguishing medical insurance types,being enrolled in basic medical insurance would result in ex-ante moral hazard in the manner of weakening health attitude,but did not increase smoking and drinking behaviors;while distinguishing the types of medical insurance,being enrolled in employee medical insurance or resident medical insurance would not generate ex-ante moral hazard due to weakened health attitude or increased smoking and drinking behaviors.On the contrary,being enrolled in employee health insurance significantly reduced the monthly alcohol consumption of the insured and improved their risk health behaviors.Finally,the paper put forward suggestions on the future focus of relevant research and the construction of medical insurance system.

关 键 词：事前道德风险 医疗保险 职工医保 

分 类 号：R197[医药卫生—卫生事业管理]