农村居民基本医疗保险的最优支付水平研究

A Study on the Optimal Payment Level of Rural Residents' Basic Medical Insurance

本文利用CHARLS数据,基于社会保险福利最大化理论,将最优报销率表示为农村居民医疗服务的需求价格弹性及消费平滑效果等充分统计量的函数。结果表明:医疗保险的消费平滑效果方面,住院报销率每提高10%,患病家庭周食品消费下降率减少3.2%;而门诊统筹保险不具有消费平滑效果;医疗服务需求价格弹性方面,住院报销率提高10%将使住院费用增加3.4%;根据最优政策公式,农村居民住院统筹保险的最优实际报销率为56%~66%,提示农村居民医疗保险的实际支付水平低于最优水平;但若是大病冲击带来剧烈的消费波动,则免费医疗才是最优保险政策。考虑到城市居民医保的需求价格弹性大于新农合,则统筹城乡居民的基本医保实际报销水平也不宜超过66%。

Based on the social insurance welfare maximization theory,the paper used CHARLS data,and represented the optimal reimbursement rate of the rural residents＇ basic medical insurance（ BMI） as a function of sufficient statistics,such as price elasticity of medical care demand and the consumption smoothing effect. The results showed：in terms of the consumption smoothing effects of BMI,once the hospitalization reimbursement ratio was increased by10%,the rate of decrease of the patient＇s weekly household food consumption would be reduced by 3. 2 percentage points,and outpatient insurance did not have consumption smoothing effects; in the aspect of price elasticity of medical care demands,a 10% rise in the hospitalization reimbursement rate would increase hospitalization costs by 3.4%; according to the optimal policy formula,the optimal payment level of inpatient insurance would be 56% ~66%,which meant that the actual payment level of BMI for rural residents was lower than the optimal level. However,if the consumption fluctuated significantly because of severe illness,the optimal policy would be free medical care. In consideration of the price elasticity of demand of urban residents＇ medical insurance being greater than that of the new rural cooperative medical insurance,the actual reimbursement level of the basic medical insurance for both urban and rural residents should not be higher than 66%.