我国医疗卫生改革中道德风险的探究及其影响

Discussion on Moral Hazard and Its Influences under China's Health Care Reform

在实证卫生经济学的研究中,如何分离逆向选择因素进而无偏的估计出道德风险的影响,一直是一个公认的难题。该研究试图使用我国过去几年医改中特有的政策变迁来获得对道德风险的准确估计。将双重差分倾向得分匹配估计方法运用在微观层面的样本医院患者数据上,评估了医疗保险补偿率的提高对医疗卫生服务需求的影响,结果发现在我国的医疗卫生改革中存在着很明显的道德风险。具体而言:如果医疗保险补偿率提高5%,其他因素不变,则相应的医疗卫生支出将增长7%左右。这一发现对学术界和当前的政策制定都有着重要的意义。我国政府承诺在"十二五"期间将个人支付医疗费比例从现在的大约37.5%降至30%以下。根据上述的估计,如果这个政策目标成功实现,单单就道德风险这一因素就会额外的消耗我国的医疗系统大约2 000亿人民币。

It is a well-recognized difficult empirical task to disentangle the moral hazard effect from adverse selection impact by using the health insurance data in the empirical research of health economics. In the research, the unique social experiment in China＇s health care reform, which enables cleanly identify moral hazard is applied. Using individual-level hospital patient data, it estimates the impact of the reimbursement rate increase on Chinese patients＇ demand for health care service. Difference-in-Difference Propensity Score Matching approach and find strong evidence for moral hazard are approached. For instance： if the reimbursement rate increases by 5% while other factors remain the same, the corresponding health care service expenditure will increase by around 7%. The finding also has important implication for policy making. Chinese government pledges to lower the average individual out-of-pocket cost from the current 37.5% of total health care service cost to 30 % in 5 years. According to the former estimation, if the goal of the policy is successfully achieved, moral hazard problem itself will cost Chinese health care system around 200 billion yuan.