基本医疗保险门诊保障水平对居民参保意愿和参保质量的影响研究  

Research on the Impact of Outpatient Security Level of Basic Medical Insurance on Residents'Willingness and Quality of Insurance Participation

作　　者：高娜娜 

机构地区：[1]河南大学经济学院,开封475004

出　　处：《中国医疗保险》2025年第1期61-68,共8页China Health Insurance

基　　金：河南省软科学研究计划项目“医疗保险基本公共服务均等化促进居民消费的机制、效应与对策研究”(242400410458)。

摘　　要：目的:分析基本医疗保险门诊保障水平对居民参保意愿、参保连续性和参保缴费档次的影响。方法:基于CHARLS 2011-2018年四期调查数据,使用门诊报销比例衡量门诊保障水平,采用Probit模型探究门诊保障水平对居民参保行为的影响。结果:基本医疗保险门诊保障水平提高能显著提升居民参保率,并且能够降低参保中断现象,提高参保缴费档次,提升居民参保质量。同时,门诊保障水平提高能够降低居民医疗保险参保的逆向选择行为,年轻人群和健康状况较好人群中门诊报销比例对参保率的影响更显著。结论:基本医疗保险门诊保障水平能够提升居民参保意愿和参保质量,建议继续稳步提高基本医疗保险门诊保障水平,适时调整门诊报销起付线,提高门诊医疗费用报销比例,扩大报销范围。建立居民基本医疗保险缴费标准与经济社会发展水平及居民人均可支配收入的联动机制,制定更精细化和差异化的缴费政策。Objective:The paper analyzes the impact of outpatient security level on residents'willingness,continuity,and payment grade of participation in basic medical insurance.Methods:Based on the CHARLS data from 2011 to 2018,the paper uses outpatient reimbursement ratio to measure the level of outpatient security,and uses Probit model to explore the impact of outpatient security level on residents'basic medical insurance participation behavior.Results:The improvement of outpatient security level of basic medical insurance can significantly increase the participation rate of residents,reduce the interruption of insurance coverage and raise the grade of insurance payment,and improve the quality of participation.At the same time,improving the level of outpatient security can reduce residents'adverse selection behavior,and the impact of outpatient reimbursement ratio on participation rate is more significant among young people and those with better health conditions.Conclusion:The level of outpatient security can enhance residents'willingness to participate in insurance and improve the quality of participation.It is recommended to improve the level of outpatient security steadily,adjust the deductible line for outpatient reimbursement,increase the proportion of outpatient medical expense reimbursement,and expand the scope of reimbursement.Also,we should promote the linkage mechanism between the payment standards of medical insurance,the level of economic and social development,as well as the per capita disposable income of residents,and formulate more refined and differentiated payment policies.

关 键 词：门诊保障水平 居民医疗保险 连续参保 

分 类 号：F840.684[经济管理—保险]