医保统筹层次、医疗服务利用与健康福利--兼论省级统筹下医疗费用上涨的中介机制  

Medical Insurance Pooling, Utilization and Welfare:Intervening Mechanisms of the Rise in Medical Expenses with Pooling at the Provincial Level

作　　者：申宇鹏 Shen Yupeng(Zhou Enlai School of Government,Nankai University,Tianjin 300350,China)

机构地区：[1]南开大学周恩来政府管理学院

出　　处：《社会保障评论》2022年第4期83-101,共19页Chinese Social Security Review

基　　金：天津市哲学社会科学规划项目“贫困老人和儿童的公平健康保障体系建设研究--以天津市为例”(TJLJ18-002)。

摘　　要：本文基于中国劳动力动态调查(CLDS)2012—2018年四期面板数据,建立渐进双重差分模型,系统检验城镇职工基本医疗保险统筹层次调整对个体医疗服务利用的影响,同时探究相应的健康福利变化和中介机制。结果显示,市级统筹未显著影响个体医疗服务利用,却带来健康福利的提升,而省级统筹在显著提高个体医疗服务利用的同时,并未带来健康福利,本文因而推断在此过程中产生了道德风险。进一步地,省级统筹下医疗费用上涨存在医疗供给方诱导需求和医疗需求方过度医疗两种中介机制,并且以上两种机制主要源自当前省级统筹模式导致的监管质量下降,由此推断省级统筹的负向效应可通过完善监管等配套政策中和。据此建议,医保统筹层次调整应首先以强化监管、做实市级统筹为宜。Based on the panel data of China Labour-force Dynamic Survey(CLDS) from 2012 to 2018, this paper takes the gradual reform of pooling levels of Urban Employee Basic Medical Insurance as policy impact, establishes a time-varying difference in differences model, systematically tests the impact of the adjustment of pooling level on medical services utilization, and explores the corresponding changes in health welfare and intervening mechanisms. The results show that raising the pooling level from counties to prefectural-level cities does not have a significant impact on individuals’ utilization of medical services, but brings about the improvement of health welfare;while moving from pooling at the prefectural-level to pooling at the provincial-level significantly improves individuals’ utilization of medical services, but does not bring about health welfare. Thus, moral hazards arise in this process. Further research shows that there are two intervening mechanisms for the rise in medical expenses: supplier-induced demand and overuse on the demand side. The above two mechanisms are mainly due to the decline in the quality of supervision. Thus, the negative impacts of provincial-level management can be reduced by strengthening regulation and supervision. Finally, this paper suggests that the rise of the medical insurance’s pooling level should be based on strengthened supervision, and solid pooling at the prefectural-level should be a priority.

关 键 词：医保统筹层次 医疗服务利用 健康福利 中介机制 渐进双重差分 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]