新农合对农村居民医疗支出的效果评价研究

Evaluation of the Effect of New Rural Cooperative Medical System on Rural Residents’ Medical Expenditure

目的探讨新农合对农村居民医疗支出的影响,为新农合政策调整提供实证依据。方法 利用2006—2011年“中国健康与营养调查数据”来评估新农合对我国农村居民医疗支出的影响情况。利用两部模型、Heckman模型和IV-Heckman模型进行统计分析,并从就医地点、医疗支出水平、收入水平等多个角度进行实证分析。结果研究发现:①新农合提高了农村居民就医率,对减少居民医疗支出起到显著作用;②新农合缓解了市级医院接纳压力,并能引导农村居民就近就医,提高医疗服务利用率;③新农合对高医疗支出的减少并不显著,报销比例仍有待扩大;④新农合对高收入人群医疗支出减少比例更大,这种差异可能加剧了不同收入人群医疗负担的不平等。结论 新农合能够加大农村居民的就医热情,改善了“有病不医”的状况。同时显著减少农村居民医疗支出,有效缓解了“看病贵”的问题,减轻居民医疗负担。

Objective To explore the effect of new rural cooperative medical system on medical expenditure of rural residents,and provide the empirical basis for the adjustment of the new rural cooperative medical system.Methods Data of the 2006-2011"China Health and Nutrition Survey"were used to estimate the effect of new rural cooperative medical system on medical expenditure of rural residents in China.Two-part models,Heckman model and IV-Heckman model,were used to analyze from multiple perspectives,such as the place of medical treatment,medical expenditure level and income level.Results①The new rural cooperative medical system increased the consultation rate of rural residents,and significantly reduced medical expenditure.②The new rural cooperative medical system alleviated the pressure on municipal hospitals to accept patients,and guided rural residents to seek medical treatment nearby,thus improved the utilization rate of medical services.③The new rural cooperative medical system did not significantly reduce the relatively higher medical expenditure,and the reimbursement ratio still need to be expanded.④The new rural cooperative medical system reduced the medical expenditure of high-income people by a larger proportion,and this difference might exacerbate the inequality of medical care burdens of different income groups.Conclusion The new rural cooperative medical system can increase the enthusiasm for medical treatment of rural residents,improve the situation of diseases without medical diagnosed.And it significantly reduces medical expenditure of rural residents,effectively alleviate the masses of expensive medical treatment,and reduce the medical care burdens of residents.