慢病致贫与多层次医疗保障研究

Poverty Caused by Chronic Disease and Multi-level Medical Insurance

切实防控慢性疾病已成为我国完善多层次医疗保障体系、落实健康中国战略的重要工作。本文利用国务院城镇居民基本医疗保险评估入户调查数据,建立三重差分计量模型,系统评估医疗保险对慢性病患者发生灾难性医疗支出的影响。结果表明:医疗保险显著提高了慢性病患者灾难性医疗支出发生风险,这种影响在较低收入组更加明显;产生这一影响的机制主要在于医疗保险显著提高了慢性病患者的医疗消费自付金额,但并未显著影响其收入水平;医疗保险提高慢性病患者灾难性医疗支出发生风险的效应是长期的,总体上呈"N"型变化,此后有逐渐上升的趋势;不同医保项目在保障程度上存在差异,对慢性病患者灾难性医疗支出发生风险的作用也有所不同,多层次医疗保障体系的构建产生了一定的协同效应。

Effective prevention and control of chronic diseases has become an important task for China to improve the multi-level medical insurance system and implement the Healthy China strategy. Based on the URBMI,this paper established a DDD econometric model to systematically assess the impact of medical insurance on catastrophic medical expenditure of patients with chronic diseases. The results show that medical insurance significantly increases the risk of catastrophic medical expenditure of patients with chronic diseases,which is more obvious in the lower income group. The main mechanism of the impact is that medical insurance significantly increases the amount of self-paid medical expenditure of these patients,but does not significantly affect their income level. The effect of insurance on increasing the risk of catastrophic medical expenditure of patients with chronic diseases is long-term,showing an "N" pattern of change on the whole,and there is a gradual upward trend thereafter. There are differences in the level of insurance coverage among different medical insurance projects,and their effects on the risk of catastrophic medical expenditure of patients with chronic diseases are also different. The construction of the multi-level medical insurance system has produced a certain synergistic effect.