逆向选择和道德风险:基于老年基本医疗保险市场的考察

Adverse Selection and Moral Hazard:Evidence from Chinese Basic Medical Insurance for the Elderly

随着我国老龄化问题的不断加剧,科学合理地识别并管理老年人医疗服务中的逆向选择和道德风险,对我国老年医疗保障意义重大。文章以中国老年人口健康影响因素跟踪调查(CLHLS)2011年数据为样本,利用Heckman模型、Probit模型和Logit模型实证分析了基本医疗保障对老年人医疗支出的影响,检验了基本医疗保险中是否存在逆向选择和道德风险。研究结果显示:基本医疗保障使老年人医疗支出显著增加;基本医疗保险中存在逆向选择,健康状况较差的老年人更倾向于参加基本医疗保险;基本医疗保险对老年人吸烟和饮酒行为没有显著影响,但是老年人参加体育锻炼的概率显著降低,一定程度上验证了道德风险的存在。

With constantly intensifying aging in China, scientific and reasonable identification and management of adverse selection and moral hazard in medical services for the elderly is of great significance to medical guarantee for the elderly. Based on the data of Chinese Longitudinal Health Longevity Survey （CLHLS） in 2011, this paper employs Heckman, Probit and Logit models to empirically study the effect of basic medical guarantee on medical expenditure of the elderly and test adverse selection and moral hazard in basic medical insurance. It reaches the fob lowing conclusions： firstly, basic medical insurance leads to the significant increase in medical spending of the elderly; secondly, there exists adverse selection in basic medical insurance, namely the elderly with poorer health is more inclined to participate in basic medical insurance; thirdly, basic medical insurance does not have the significant effect on smoking and drinking behavior of the elderly, but the possibility of participating in physical exercise significantly reduces, confirming the existence of moral hazard to some extent.