社会医疗保险制度整合模式与制度运行效率研究——来自A市的微观证据

Integration of Social Health Insurance Program and Operation Efficiency of the Health Insurance Program:Micro Evidence from City A

从理论和实证两方面对中国社会医疗保险制度整合模式与制度运行效率进行研究,并首次利用来自A市社会医疗保险信息管理系统的微观数据进行实证分析。实证结果表明,采用"多种标准"模式整合的基金可持续性优于"一种标准"模式。这一结果验证了本文的理论模型,即"多种标准"模式能缓解事前医疗服务需求较低的参保人在事后出现道德风险所致的医疗保险基金支出不合理增长现象。另外,具体研究了采用"多种标准"模式整合后的制度运行效率。

Two modes have been developed in China＇s medical insurance system integration： ＂Single System,Multi- Standard＂mode（ hereinafter called as＂Multi- Standard＂） and＂Single System,Single-Standard＂mode（ hereinafter called as＂Single- Standard＂）. We study the mode of medical insurance system integration and the efficiency of medical insurance system theoretically and empirically. Using micro data from social medical insurance information management system of city A,we find that the sustainability of＂Multi Standard＂ is better than＂Single Standard＂. The results testify the theoretical prediction that ＂Multi Standard＂mode can relief the unreasonable increase of social medical insurance fund,which is caused by the moral hazard of low ex ante demand patients. Meanwhile,we study the efficiency of ＂Multi Standard＂mode in detail.