健康结果、医疗保险与不健康行为的理论分析

Theoretical Analysis on Health Condition,Medical Insurance and Unhealthy Behaviors

医疗保险在保障健康结果的同时,也可能诱导被保险人参与不健康行为、降低出险前的预防投入,从而增加医保基金支出。当前医保制度"重治疗、轻预防",属事后补偿,难以引导被保险人重视疾病预防和养成健康行为;医保制度顶层设计的同质性,又难满足不同被保险人的多样化需求。因此,必须通过文献研究,利用期望效用函数,选取收入、税率、保费、健康结果、医疗服务价格、保费自付比例、医疗服务使用量7个外生变量,从理论上分析三者交互影响的结果。研究发现,医疗保险存在对不健康行为的诱导影响,且受健康结果的干扰,存在时变差异和个体差异。医保制度需从机制层面进行调整或改革,将单一的治疗目标为主转变为预防为主,并加大对保障人群健康行为的有效引导。

Medical insurance can promote health status,but it can also lead the insured to unhealthy behavior,reduce self-protection investment,and eventually increase the fund spending on medical insurance.And the current medical insurance system focus more on treatment,an ex post compensation,than disease prevention,so it is difficult to guide the insured to pay attention to prevent disease and develop health behaviors.Besides,because of its homogeneity it is difficult for the medical insurance system to meet the diverse needs of different insured persons.Therefore,it is necessary to conduct a literature review on the relationship among health status,medical insurance and unhealthy behaviors.By using the theory of expected utility function,seven exogenous variables,such as income,salary tax rate,premium,health outcome,medical service price,copayment rate and medical treatment,were selected to analyze the interaction results of the above three factors.It improved that medical insurance has had an induced effect on unhealthy behaviors,which were disturbed by healthy outcomes,and existed timevarying differences and individual differences.Therefore,the medical insurance system needs to be adjusted or reformed from the mechanism level,changing the main aim of the insurance from treatment to prevention and providing effective guidance to the insured.