近二十年我国社会医疗保障制度改革对患者的实际影响:患者就诊实际报销比例研究

Study on the Impact of Public Health Insurance System Reform over 20 Years in China,How Patient's Actual Reimbursement Rate Changed

目的:以患者因就诊所产生费用的实际报销比例为切入点,探讨在近20年各个阶段的医疗保障制度改革对于不同群体的影响。方法:建立计量经济学模型,重点分析不同医疗保障制度随着一系列改革而导致的患者实际报销比例的变化。结果:患者实际报销比例在不同保险项目之间存在着较大的差异,一系列针对于不同人群的医疗保险政策调整对实际报销比例有一定的影响。讨论:不同社会医疗保险制度的报销比例存在较大差异,低家庭收入患者实际报销比例较低。结论:改革在近十年取得了一些成效,但患者的实际报销比例在不同人群不同地区之间仍存在着较大的差异,减少差异使社会医疗保障制度更加趋向于公平应当是下一步政策调整的重点。

The public Health insurance system reform has become an important policy in China for last two decades and a series task of different waves of reform is to enlarge the insurance coverage. The paper uses the China Health and Nutrition Survey （University of North Carolina at Chapel Hill） from 1991 to 2009, to discuss the effect of health insurance on patient＇s actual reimbursement rate for their health services across series waves of reform. By using linear regression model, I investigate how different heahh insurance programs affect tile actual reimbursement rate across years, with several control variables. The result indicates that the rate shows huge disparity over different type of heahh insurance programs across years. Also for low income patients, their actual reimbursement rate is lower than other population. The resuhs of this research suggest that expanding health insurance alone is not sufficient, and instead the reform must go furtber to bridge the ditferences between various types of health insurance programs to achieve social welfare equity.