社会医疗保险中的过度需求和供给诱导研究——来自CHNS的证据

A research on Excess Demand and Supplier Induced Demand in Social Health Insurance——Based on Evidences from CHNS

基本医疗保险市场具有非常显著的信息不对称的特征,会产生需求方的过度需求和供给方的供给诱导。本文使用1989年到2011年"中国健康与营养调查数据库"(CHNS)的数据,使用四部分模型检验的结果表明:门诊支付比率提高显著增加门诊医疗支出11. 5%,住院支付比率提高显著增加住院医疗支出19. 2%;供给增加带来门诊医疗支出增加(10.2%,9. 1%)和住院医疗支出增加(6%,0. 8%)。对需求进一步检验的结果发现当个人自负医疗支出占收入的比例低于40%时,存在过度需求引起的医疗支出增长,而高于40%时,医疗支出增长更多的是需求的释放。对供给进一步检验的结果发现在医疗资源丰富的地区医疗支出增加存在供给诱导,而医疗资源贫乏的地区医疗支出增加更多是可近性增加。本文的研究为进一步完善我国基本医疗保险制度提供了理论和实证依据。

The basic medical insurance market has a significant feature of information asymmetry which results in excess demand and supplier induced demand. This paper used data of China Health and Nutrition Survey （CHNS） from 1989 to 2011, and through the four part model test, it revealed that the outpatient payment ratio significantly increased outpatient medical expenditures by 11.5% , and the inpatient payment ratio significantly increased inpatient expenditure by 19.2%. The paper also found that an increase in the supply increased outpatient health expenditure by （ 10.2% ,9.1% ） and increased inpatient medical expenditure by （6% ,0.8% ）. Further test for demand found that if the proportion of out-of-pocket medical expenses was below 40%, there was an increase in health spending caused by excess demand, and if the proportion was higher than 40%, the increase in health spending was mostly due to release of demand. Further test for supply found that there was supplier induced demand in the regions with rich medical resources, while the increase in health spending in the regions with poor medical resources region was mostly due to accessibility. The paper provides theoretical and empirical basis for further improving the social medi- cal insurance system in China.