城乡居民医保整合对农村中老年人医疗服务利用的影响  

The Impact of Urban-rural Integration of Medical Insurance on Medical Services for Middle-aged and Elderly People in Rural Areas

作　　者：覃诚 朱雨晨 方向明[1] 汪宝 Qin Cheng;Zhu Yuchen;Fang Xiangming;Wang Bao

机构地区：[1]中国农业大学经济管理学院

出　　处：《兰州学刊》2023年第6期147-160,共14页

基　　金：国家社会科学基金重点项目(项目编号:21AJL015);清华大学中国农村研究院博士论文奖学金项目(项目编号:202119)。

摘　　要：医疗保险的设立初衷是促进医疗服务利用。医疗保险的建立和迅猛发展带动了中国医疗保健事业的飞速发展。文章采用中国健康与养老追踪调查(CHARLS)2015年和2018年数据,利用双重差分回归模型实证分析了城乡居民医保整合对农村中老年人医疗服务利用的影响。主要结果如下:第一,城乡居民医保整合影响了农村中老年人医疗服务利用。表现为门诊利用概率和次数、费用的提升,以及住院费用的下降。第二,异质性分析方面,城乡居民医保整合更积极促进了中年人、东部地区、“一制多档”医保模式地区的医疗服务利用。第三,进一步分析发现,城乡居民医保整合影响医疗的可能机制是提高医疗报销率,消除了城乡医保差距,促进其就医,并且去更高级别医院就医,减少患者的住院次数,缩短了住院时间。同时门诊利用率的提高,可能会避免小病拖成大病。最后提出继续提升城乡居民医保的统筹层次,建立与收入和年龄相关的医保筹资和待遇保障体系,加快门诊统筹,扩大慢性病门诊报销的覆盖面,完善医疗保障的疾病预防、健康管理功能的政策建议。The original intention of establishing medical insurance is to promote the utilization of medical services.The establishment and rapid development of medical insurance have led to the rapid development of China’s medical and health care industry.Using data from the China Health and Elderly Care Tracking Survey(CHARLS)in 2015 and 2018,this paper empirically analyzes the impact of urban-rural residents’health insurance integration on the utilization of medical services for the elderly in rural areas using a dual differential regression model.The main results are as follows:First,the integration of medical insurance for urban and rural residents has affected the utilization of medical services for the elderly in rural areas.It is manifested by the increase in the probability and frequency of outpatient utilization,as well as the increase in expenses,as well as the decrease in hospitalization expenses.Secondly,in terms of heterogeneity analysis,the integration of medical insurance for urban and rural residents has more actively promoted the utilization of medical services for middle-aged people,high-income groups,eastern regions,and areas with a“one system multiple file”medical insurance model.Thirdly,further analysis found that the possible mechanism by which the integration of medical insurance for urban and rural residents affects medical treatment is to increase the medical reimbursement rate,eliminate the urban-rural medical insurance gap,promote medical treatment,and go to higher level hospitals to reduce the number of inpatients and shorten the length of hospitalization.At the same time,the improvement in the utilization rate of outpatient services may prevent minor diseases from becoming serious diseases.Finally,policy recommendations are proposed to continue to improve the overall level of medical insurance for urban and rural residents,establish a medical insurance financing and treatment guarantee system related to income and age,accelerate outpatient coordination,expand the coverage of outpatient

关 键 词：医保整合 农村 中老年人 医疗服务利用 

分 类 号：F842.0[经济管理—保险]