资源消耗视角下职工医保统筹层次提升的绩效分析:兼论效率与公平  

Performance analysis of increasing pooling level of employee medical insurance from the perspective of resource consumption:An integrated analysis of efficiency and equity

作　　者：孙菊[1,2] 杨一帆 李浩淼[1,2] SUN Ju;YANG Yi-fan;LI Hao-miao(School of Political Science and Public Administration,Wuhan University,Wuhan Hubei 430072,China;The Research Center for Health Governance,Wuhan University,Wuhan Hubei 430072,China)

机构地区：[1]武汉大学政治与公共管理学院,湖北武汉430072 [2]武汉大学健康治理研究中心,湖北武汉430072

出　　处：《中国卫生政策研究》2024年第11期1-9,共9页Chinese Journal of Health Policy

基　　金：国家卫健委卫生技术评估重点实验室2023-2024年度开放基金(FHTA2023-04)。

摘　　要：本研究基于中国家庭追踪调查数据,从医疗资源消耗视角,结合效率与公平,检验职工医保统筹层次提高的绩效。结果表明,职工医保市级统筹和省级统筹具有明显不同的绩效表现,市级统筹在并未增加资源消耗的情况下改善了参保人的健康水平,省级统筹显著增加了医疗资源消耗和医保基金支出,却并未改善参保人健康水平。此外,省级统筹还加剧弱势地区基金风险和弱势人群医疗服务利用的实质不公。因此,在推进省级统筹前,应夯实市级统筹,注重健康绩效,兼顾医保基金效率与区域、人群公平,稳慎推进省级统筹。Based on data from the China Family Panel Studies,this study examined the effects of higher pooling levels of Employee Medical Insurance from the perspective of medical resource consumption,considering both efficiency and equity.The results showed significant differences between municipal-level and provincial-level pooling.Municipal-level pooling improved the health of insured individuals without increasing resource consumption.In contrast,provincial-level pooling significantly increased medical resource consumption and insurance fund expenditures without better health outcomes.Furthermore,provincial-level pooling exacerbated fund risks in disadvantaged areas and inequities in medical service utilization for disadvantaged populations.Therefore,before promoting provincial pooling,current reforms should focus on strengthening municipal-level pooling,while paying attention to health performance,giving full consideration to the efficiency of medical insurance funds and the equity between regions and populations,steadily promoting provincial pooling.

关 键 词：医保统筹层次 资源消耗 效率 公平 交叠双重差分法 

分 类 号：R197[医药卫生—卫生事业管理]