财政卫生支出:提升健康与降低费用——兼论企业医保降费

Government Health Expenditure:Improving Health or Reducing Expenditure?

2009年我国新一轮医药卫生体制改革(以下简称"新医改")启动以来,财政卫生支出呈现出新的特点:一是财政对供方的投入重点由公立医院转向基层医疗卫生服务("强基层");二是财政补贴重点从医疗卫生机构转向医疗保障("补需方")。那么,新医改以来财政支出对提升健康水平、降低医疗费用的作用如何?本文利用2009—2016年我国省级面板数据,使用系统GMM估计方法对此进行了实证分析,结果发现:(1)财政卫生支出显著促进了居民的医疗服务利用,"强基层"和"补需方"均显著改善了居民健康。这表明财政卫生支出是必要的,还可以降低当前较高的企业医保缴费负担。(2)财政卫生支出对医疗费用、个人医疗负担的影响尚不确定,"强基层"降低了医疗费用,减轻了医疗负担,"补需方"则相反。本文的主要建议是政府应当坚持对基层医疗卫生服务的投入,同时加强医保的科学控费机制建设,并特别为降低企业医保缴费腾出空间。

A new healthcare reform plan was released to the public in 2009.A central feature of this reform was a call for the government health expenditure.Since New Healthcare Reform,China’s government health expenditure has shown some new features.On the one hand,the focus of financial input to suppliers of medical service has shifted from public hospitals to primary health institutions(Subsidy primary service),on the other hand,government changed its focus from subsidizing medical institutions to subsidizing medical security(Subsidy demand side).Subsidizing primary care service and basic medical security have become the largest part of government health expenditure.Whether the government health expenditure policy should be insisted depends on the effect of these inputs on improving health.Based on 2009-2016 provincial panel data and system GMM estimate method,this paper constructs two key variables to measure government health expenditure directly and examines the effect of government health expenditure on health and medical expense with estimate method.In the model of outpatient medical service utilization,the coefficient of subsiding primary service is significantly positive but not significant on inpatient service,indicating that the financial input on primary healthcare service can improve the accessibility of medical service to a certain extent since New Healthcare Reform,especially on outpatient service.The coefficient of subsiding demand side on inpatient medical service utilization is significantly positive,but not significant on outpatient service utilization.This indicates that financial input on basic medical insurance has improved accessibility of medical services,which also be consistent with medical insurance policy that mainly compensates hospitalization expenses.In the model of health,the coefficient of subsiding primary service on maternal mortality and perinatal mortality are significantly negative,indicating that financial input on primary medical service can improve people’s health status.This may be related to the improvement of accessibility of medical service,which help avoid disease deterioration caused by delays in treatment.The coefficient of subsiding demand side on maternal mortality is significantly negative,and the coefficient on perinatal mortality is negative but not significant.This shows that financial input on medical insurance can improve people’s health level.Consistent with the finding above,subsiding demand side promotes the use of medical services,then improve health.Moreover,China’s current medical insurance is still in a stage of wide coverage and low level of protection,medical expenditure has a high marginal output for health,thus increasing input on medical security has positive effect on improving health.In the model of medical expenditure,the coefficient of subsiding primary service on medical expenditure is negative but not significant,and the coefficient on personal medical burden is significantly negative.This shows that financial input on primary services can reduce the growth of medical expenses to a certain extent and effectively reduce the personal medical burden.However,the coefficients of subsiding demand side on medical expenses and medical burden are significantly positive,indicating that medical insurance has contributed to the increase of medical expenses.In general,the results show that financial input on either primary service or basic medical insurance has positive effect on improving health and decreasing medical expenditures to a certain extent.In detail,government health expenditure stimulates both inpatient and outpatient medical service utilization,hence improves the health status,whether subsiding primary service or demand side.But it’s unsure that how the government health expenditure affects the medical expense.Subsiding primary services can reduce both medical expense and medical burden while subsiding demand side can’t.Therefore,the paper suggests that for better health status and controllable medical expenditure government should keep increasing the input to public health and basic medical services and strengthening the construction of cost control mechanism of medical insurance.