城乡居民基本医疗保险省级统筹对我国居民医疗费用支出和健康状况的影响  

The Impact of Provincial Pooling of Urban and Rural Resident Basic Medical Insurance on Residents'Medical Expenses and Health Status in China

作　　者：甘晓成[1,2] 姚娇 蔡瑶瑶 GAN Xiaocheng(School of Politics and Public Administration,Xinjiang University,Urumqi,Xinjiang,830046,China)

机构地区：[1]新疆大学政治与公共管理学院,新疆乌鲁木齐830046 [2]新疆大学国家安全研究省部共建协同创新中心,新疆乌鲁木齐830046 [3]北京航空航天大学社会保障研究中心,北京100190

出　　处：《医学与社会》2024年第4期90-96,共7页Medicine and Society

基　　金：国家社会科学基金资助项目,编号为20BGL005;新疆维吾尔自治区社会科学基金资助项目,编号为21BGL103;新疆维吾尔自治区医疗保障局立项课题,编号为TQZB-2022-015。

摘　　要：目的:探讨城乡居民基本医疗保险省级统筹对我国居民医疗费用支出和健康状况的影响,为未实现省级统筹的省份提供参考和建议。方法:基于2016、2018和2020年中国家庭追踪调查3期数据,结合当前已经实施城乡居民基本医疗保险省级统筹省份的政策,采用渐进双重差分等方法分析居民医保省级统筹后住院费用、门诊费用和自付费用的变化情况,并进一步探究政策实施后居民健康状况的变化。结果:共筛选出2847个样本,城乡居民基本医疗保险省级统筹与居民住院费用(β_(1)=-0.589,P<0.01)和门诊费用(β_(1)=-1.321,P<0.01)呈现显著负相关,与自付费用(β_(1)=1.975,P<0.01)呈现显著正相关。政策实施4年后自付费用、门诊费用和住院费用均有显著上升趋势。政策实施后城乡居民的自评健康(α_(1)=-1.559,P<0.01)和健康变化(α_(1)=-0.495,P<0.01)得到改善。结论:实施城乡居民基本医疗保险省级统筹政策不仅可以显著降低居民的医疗费用支出,还能改善他们的健康状况。因此要不断完善基金监管和控费机制,合理划分各级财政责任,科学统筹推进政策实施。Objective:To explore the impact of provincial pooling of basic medical insurance for urban and rural residents on medical expenditure and health status,so as to provide reference and suggestions for provinces that have not yet realized provincial pooling.Methods:Based on the panel data of China Family Panel Studies in 2016,2018 and 2020,the changes of inpatient expenses,outpatient expenses and out-of-pocket expenses after the implementation of provincial pooling of basic medical insurance for urban and rural residents were analyzed,based on the policy of provincial pooling of basic medical insurance had been implemented,using progressive difference-in-difference to test.Further had explore the health level and health changes after the implementation of the policy.Results:A total of 2847 samples were selected.The provincial pooling of basic medical insurance for urban and rural residents showed significant negative corelation with hospitalization expenses(β_(1)=-0.589,P<0.01)and outpatient cost(β_(1)=-1.321,P<0.01),and significant positive correlation with out-of-pocket cost(β_(1)=1.975,P<0.01).Four years after the implementation of the policy,the out-of-pocket expenses,outpatient expenses and hospitalization expenses all showed a significant upward trend.The self-rated health(α_(1)=-1.559,P<0.01)and health change(α_(1)=-0.495,P<0.01)of urban and rural residents were improved after the implementation of the policy.Conclusion:The implementation of the provincial pooling policy of basic medical insurance for urban and rural residents can not only significantly reduce residents'medical expenses,but also improve their health conditions.Therefore,it is necessary to constantly improve the fund supervision and fee control mechanism,rationally divide financial responsibilities at all levels,and scientifically coordinate the implementation of policies.

关 键 词：城乡居民基本医疗保险 省级统筹 医疗费用 健康 

分 类 号：R-05[医药卫生]