医保预付制改革的效果研究——来自中国CHIRA数据的实证检验

A Research on the Effect of Medical Insurance Prepayment Reform——An empirical analysis based on CHIRA data

推进医保支付方式改革是完善中国特色医疗保障制度的重要内容,对于规范医疗服务行为、引导资源配置、控制医疗费用不合理增长具有重要意义。本文利用中国医疗保险研究会2014~2017年CHIRA数据库,抽取了16个城市134522条住院患者样本,采用处理效应模型对医保预付制改革的效果进行研究。研究结果显示,医保预付制可以显著降低参保患者的住院费用,但也发现患者自付费用和住院天数有所上升。不同等级医院、不同等级城市间医保预付制控费效果存在明显的异质性,其中三级医院和一级城市控费效果最弱。进一步对医保预付制的控费机制进行研究发现,医保预付制改革存在"分配效应",医疗机构可能通过在一年不同时段分配医保额度来满足总额预付的要求。建议通过信息化手段实现区域间医保支付价格的比较,建立激励相容的医保支付机制,结合其他医保改革政策进一步积极探索多元复合支付方式。

Promoting the reform of medical insurance payment is an important part of improving the medical security system with Chinese characteristics, which is of great significance for standardizing medical service behaviors, guiding resource allocation, and controlling the unreasonable growth of medical expenses.Using the China Medical Insurance Research Association′s CHIRA database from 2014 to 2017,we selected 134522 inpatients from 16 cities, and used the treatment effect model to evaluate the effect of medical insurance prepayment reform.The results show that the prepayment can significantly reduce the hospitalization expenses of the insured patients, but the out of pocket expenses and hospitalization days have increased.There is obvious heterogeneity in the expenses control effect among hospitals of different levels and cities of different levels, among which the third level hospital and the first level city have the weakest effect.It is found that there is a "distribution effect" in the medical insurance prepayment reform, and medical institutions may allocate the amount of medical insurance in different periods of a year to meet the requirement of total prepayment.It is suggested to realize the comparison of medical insurance payment price between regions by means of information technology, establish incentivizing and compatible medical insurance payment mechanism, and further actively explore multiple compound payment methods in combination with other medical insurance reform policies.