共同富裕背景下基本医疗保险省级统筹对医疗支出负担的影响  

In the Context of Common Prosperity the Impact of Provincial Overall Planning of Basic Medical Insurance on the Burden of Medical Expenditure

作　　者：贾茜媛 张鑫武[1] 周明[1] JIA Xiyuan;ZHANG Xinwu;ZHOU Ming(School of Public Administration,Northwestern University,Xi’an 710127,China)

机构地区：[1]西北大学公共管理学院,陕西西安710127

出　　处：《西安财经大学学报》2023年第3期76-86,共11页Journal of Xi’an University of Finance and Economics

基　　金：国家社会科学基金重大项目“海峡两岸劳动力流动现状调查与劳动权益保障研究”(18ZDA083)。

摘　　要：医疗保险统筹层次是我国医疗保险制度改革的重要内容;降低医疗支出负担,增加其他消费支出是共同富裕的内在要求,能否基于共同富裕背景下分析医疗保险统筹层次改革对医疗支出负担的影响,是值得关注的焦点问题。文章基于2003—2018年30个省份面板数据,采用多期差分法(Difference in Difference)和固定效应模型(FE),实证检验了共同富裕背景下城镇职工医疗保险省级统筹对城镇居民自付医疗费用的影响。研究结果表明,在共同富裕背景下,城镇职工医疗保险省级统筹显著增加了城镇居民自付医疗费用,该结论通过了稳健性检验。中间机制分析表明,在共同富裕背景下,城镇职工医疗保险省级统筹的“公平效应”与“规模效应”在降低了城镇居民自付医疗费用方面的作用并不显著,而其导致的道德风险显著增加了城镇居民自付医疗费用。异质性分析表明,城镇职工医疗保险省级统筹对城镇居民自付医疗费用的影响存在经济发展水平和政府财政医疗卫生支出的异质性。因此,未来医疗保险制度改革重点在于建立省级统筹垂直管理模式,强化医疗保险提高重大疾病医疗服务可及性的功能,并缩小不同经济发展水平地区间医保待遇差距,降低医疗支出负担,实现共同富裕。The overall level of medical insurance is an important part of the reform of my country’s medical insurance system;reducing the burden of medical expenditures and increasing other consumer expenditures are the inherent requirements of common prosperity.Can we analyze the impact of the reform of the medical insurance overall level on the burden of medical expenditures based on the background of common prosperity?Focus issues worthy of attention.Based on the panel data of 30 provinces from 2003 to 2018,the article uses the difference in difference method and the fixed effects model(FE)to empirically test the urban employee medical insurance under the background of common prosperity.The impact of costs.The results of the study show that,in the context of common prosperity,the provincial-level overall planning of urban employee medical insurance has significantly increased the out-of-pocket medical expenses of urban residents.This conclusion has passed the robustness test.The analysis of the intermediary mechanism shows that under the background of common prosperity,the“fair effect”and“scale effect”of the provincial overall planning of urban employee medical insurance are not significant in reducing urban residents’out-of-pocket medical expenses,and the resulting moral hazard Significantly increased the medical expenses paid by urban residents.Heterogeneity analysis shows that the impact of urban employee medical insurance on the out-of-pocket medical expenses of urban residents is heterogeneous in the level of economic development and government financial medical and health expenditures.Therefore,the future reform of the medical insurance system focuses on establishing a provincial-level integrated vertical management model,strengthening the function of medical insurance to improve the accessibility of medical services for major diseases,and narrowing the medical insurance benefit gap between cities and counties,reducing the burden of medical payment,and achieving common prosperity.

关 键 词：共同富裕 医疗保险统筹层次 公平效应 规模效应 道德风险 医疗支出负担 

分 类 号：F840.613[经济管理—保险]