两保合一对医疗费用的影响:基于单一支付者制度的视角  

The Impact of Insurance Consolidation on Medical Expenditures:Perspective from Single-payer System

作　　者：赖毅 李玲[1] 陈秋霖 Lai Yi;Li Ling;Chen Qiulin(National School of Development,Peking University;The Institute of Contemporary China Studies,Chinese Academy of Social Sciences;School of Applied Economics,University of Chinese Academy of Social Sciences)

机构地区：[1]北京大学国家发展研究院 [2]中国社科院当代中国研究所 [3]中国社科院大学应用经济学院

出　　处：《管理世界》2022年第7期147-162,共16页Journal of Management World

基　　金：国家社科基金重大项目“健全基本医疗卫生制度研究”(基金号:20ZDA075)的资助。

摘　　要：本文利用2009~2015年全国公立医院财务报表数据,通过新农合与城居保合并发生的时间先后,来识别保险合并对医疗费用的影响。两保合一时,新农合与城居保的基金池合并,医保经办机构统一并成为地级市层面的单一管理者。本文发现两保合一使医保买方市场势力增强,赫芬达尔指数上升,进而医院收入下降3.6%,次均医疗费用下降2.9%,总诊疗量无显著变化,医院收入下降主要是次均药品费用下降带来的。若改革前地级市的赫芬达尔指数越小,则其买方市场势力增幅越大,控费效应越明显。而且对于市场份额更大的医院,两保合一的控费效应更小,这代表医保与医院的相对市场势力共同影响医疗费用。但本文也发现控费效果是短期的,而且病人自付费用占比提高,说明医院诱导了自费费用。Using the 2009-2015 national public hospital financial data,this article identified the causal effects of insurance consolidation on medical expenditures by exploiting timing variation of Urban-Rural Health Insurance Integration in China.The merger of two social health insurances(NCMS and URBMS)consolidated the two health insurance funds and relevant administration authority,and formed a monopoly buyer of medical services at the prefecture level.The paper found that the merger increased the market power,thus reduced the hospitals’revenue by 3.6%,per capita medical expenditure by 2.9%,without influencing the volume of services.The decrease of revenue was mainly attributed to the decrease of per capita drug expenditure.The city with a lower HHI of insurance before the consolidation experienced a larger increase of HHI,thus a larger expenditure reduction.Moreover,the hospital with a larger market share experienced a milder expenditure reduction.The above two facts indicated that the relative bargaining power between insurances and hospitals influences the medical expenditures.However,the consolidation didn’t have long-term effect.Besides,the proportion of out-of-pocket expenditure rised,indicating hospitals might induce patients to use more out-of-pocket services.

关 键 词：医保整合 单一支付者制度 市场势力 供方费用控制 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理] F323.89[医药卫生—公共卫生与预防医学]