医疗保险会引致道德风险吗?——以城乡居民医保为例  

Does medical insurance cause moral hazard:Take medical insurance for urban and rural residents as an example

作　　者：张航空[1,2,3] 马琦峰 ZHANG Hang-kong;MA Qi-feng(School of Population and Health,Renmin University of China,Beijing 100872,China;Population Development Studies Center,Renmin University of China,Beijing 100872,China;Institute of Gerontology,Renmin University of China,Beijing 100872,China)

机构地区：[1]中国人民大学人口与健康学院,北京100872 [2]中国人民大学人口与发展研究中心,北京100872 [3]中国人民大学老年学研究所,北京100872

出　　处：《中国卫生政策研究》2024年第10期9-16,共8页Chinese Journal of Health Policy

基　　金：北京市社会科学基金青年项目(18SRC022)。

摘　　要：文章使用2005—2018年中国老年健康影响因素跟踪调查的五期平衡面板数据,使用双向固定效应模型,分析参加城乡居民医保对老年人道德风险的影响。研究发现,参保并不会引致老年人不健康行为增多的事前道德风险,但会带来医疗费用支出上涨的事后道德风险;年龄越小、健康状况变差的老年人在参保后更易出现医疗费用支出上涨的事后道德风险;相较于城镇居民医保,老年人在参加新农合后更易出现医疗费用支出上涨的事后道德风险,参保引致的事后道德风险主要来源于门诊支出上涨。这启示我们一是要清晰认识医疗卫生政策评估的多维属性,二是要创新城乡居民基本医疗保险制度的发展理念。This study utilizes balanced panel data from five waves of the Chinese Longitudinal Healthy Longevity Survey(CLHLS)spanning 2005 to 2018 to analyze the impact of urban and rural resident medical insurance participation on moral hazard among older adults.The research findings are as follows:Firstly,participation in urban and rural resident medical insurance does not increase ex-ante moral hazard,such as unhealthy behaviors among older adults.However,it does result in ex-post moral hazard,indicated by a rise in medical expenditures.Secondly,younger seniors and those with deteriorating health conditions are more likely to experience increased medical expenses as an ex-post moral hazard after enrolling in the insurance.Lastly,compared to basic medical insurance for urban residents,older adults are more likely to experience increased medical expenses as an ex-post moral hazard after enrolling in the New Rural Cooperative Medical Scheme,primarily due to a rise in outpatient expenses.First,A comprehensive understanding of the multi-dimensional attributes of public healthcare policy evaluation is needed;Second,We should innovate the development concept of the basic medical insurance system for urban and rural residents.

关 键 词：城乡居民医保 老年人 事前道德风险 事后道德风险 固定效应模型 

分 类 号：R197[医药卫生—卫生事业管理]