政府财政投入模式对医疗费用的影响  

Effects of Public Expenditures on Health Care Cost in China

作　　者：朱恒鹏[1] 岳阳 续继 ZHU Hengpeng;YUE Yang;XU Ji(Institute of Economics,Chinese Academy of Social Sciences;School of Economics,and Wang Yanan Institute for Studies in Economics,Xiamen University;School of Economics,University of chinese Academy of Social Sciences)

机构地区：[1]中国社会科学院经济研究所、中国社会科学院大学经济学院,100836 [2]厦门大学经济学院与王亚南经济研究院、计量经济学教育部重点实验室(厦门大学),361005

出　　处：《经济研究》2021年第12期149-167,共19页Economic Research Journal

基　　金：世界银行科研项目(SBS-2020-03);亚洲发展银行科研项目“财政体制现代化视角下的公共服务与社会保障制度改革”;国家自然科学基金项目(72173106、72133004、71803165)的阶段性成果。

摘　　要：财政投入能否改善医疗服务质量,降低人民群众医疗负担,是完善我国医疗财政投入制度的核心问题。为此,本文首先构建了一个财政投入、患者就医选择和医院投资及收费行为的理论模型,分析财政投入对医院投入和收费行为的影响。模型预测对供方的财政投入,导致医院规模扩张,进而通过增加住院人次以及患者的均次支付意愿抬高医疗费用。对于需方即医保的补贴也会抬高医疗费用,但和差异化的补供方投入不同,无差异普惠性的医保促进了医院间的竞争,这使得补需方导致的医疗费用增幅低于补供方导致的医疗费用增幅。此外,由于医疗成本差异,对高等级医院的财政补贴使医疗费用的提升效应超过对低等级医院补贴的效应。本文利用13个地市的医院微观数据,衡量了财政投入(补供方)和医保支付(补需方)对医疗费用和服务质量的影响,并分析了财政投入对医疗费用产生影响的各种渠道。结果表明,增加公立医院财政投入会加剧其规模扩张,进而通过提高住院率抬高均次医疗费用,同时增加患者自费费用;医保支付增加亦会抬高均次医疗费用,但能够降低患者自费费用,实证分析结果和理论分析预测一致。The Chinese government’s health care expenditure has grown significantly over the past several decades and is projected to grow in the future.In 2020,the Chinese government spent about 7.1%of its financial expenditure on health care,increased from 6.8%in 2013.The funding to China’s public health care institutions has increased from CNY 489 billion in 2013 to CNY 755 billion by 2020,which account for 52%of total health care expenditures by then.Government subsidies on China’s public insurance programs were CNY 1.4 trillion in total from 2016 to 2020.The government spending on health care systems was supposed to reduce the burden of people’s health care spending.However,the rapid expansion of government health care spending came with the escalating expenditures of medical care,because of the problems of supplier-induced demand.Therefore,in this paper,we investigated the effects of different types of government health care expenditures on health cost and health care market in China.We first developed a static medical market competition model to investigate the effects of different types of public health care expenditures on patients’hospital choices,and hospitals’decisions of investment and pricing.In the model,we assume that a government can invest in public hospitals or subsidize the public insurance program,given the fixed total health care budget.A fixed number of patients are choosing hospitals by comparing the quality and prices of the hospitals.A primary public hospital,a tertiary public hospital and a private hospital are competing for patients by investing on beds and setting price.In the model,government spending on the supply side or demand side can affect health care cost by affecting the hospitalization rate of each hospital and patients’hospital choices.The model predicts that the government expenditures on supply sides causes hospitals to invest more in medical facilities and beds,which lead to more inpatients and higher average medical payment willingness,and further a higher medical co

关 键 词：医疗卫生 财政投入 医院投资 

分 类 号：R197.1[医药卫生—卫生事业管理]