医疗保险、户籍制度与医疗服务利用——基于CHARLS数据的实证分析

Medical Insurance,Household Registration System and Healthcare Utilization—Evidences from CHARLS Data Analysis

根据北京大学NIH支持开展的"中国健康与养老追踪调查"全国数据,本文从微观角度探究在全民医保制度背景下,不同户籍的医保持有者在医疗服务使用上的差异。Heckman和GLM计量模型的实证结果显示:第一,对于同样拥有医疗保险的受访者,其就医可及性和医疗资源使用情况存在明显的城乡差别,普遍来看,医疗保险对农村户口受访者的积极作用远低于城镇户口受访者,这主要体现在就医积极性和医疗费用负担上;第二,对于农村医疗保险持有者,其在就医过程中可能面临更多的诱导需求。此外,前往公立医院就诊所产生的医疗费用显著地高于在私立医院接受治疗所产生的医疗费用。

Using the data from Peking University NIH-funded China Health and Retirement Longitudinal Survey （CHARLS）, this paper studied the differences in healthcare utilization among people with different household registration systems under the universal social healthcare background. The Heckman and GLM models revealed the fol lowing major findings. First, for the interviewees having medical insurance, the access to and utilization degree of medical care were different between urban and rural areas. Generally, the positive effects of medical insurance towards the rural interviewees were far below their urban counterparts, which were mainly reflected in the proactiveness for taking a medical treatment and financial burden of illness. Second, when seeking health care, the rural medical insurance holders seemed to face more induced demands, and public hospitals seemed to charge significantly higher than private counterparts.