居民医保对居民健康及医疗负担的影响——来自门特病患者医疗支出的证据

The Effect of Urban and Rural Resident Basic Medical Insurance on Residents’Health and Medical Expenditure:Evidence from the Medical Cost of Outpatients with Specific Disease

居民基本医疗保险制度作为我国基本医疗保障体系的重要组成部分,政府为其发展提供了大量的财政支持。因此,居民医保是否切实改善了居民的健康状况并减轻其医疗负担需要着重探讨。以政府向居民医保支付的财政补贴作为切入点,随着国家对居民医保补贴的增加,门特病患者的并发症数量显著减少,居民自付医疗费用和实际自付比例却逐渐增加。这说明在此过程中虽然居民的健康状况有所改善,但医疗负担并未减轻。通过进一步分析居民对医疗服务的利用情况可知,该结果可能与诊疗过程中居民为享受更高水平的医保报销待遇而发生转移住院的行为有关。因此,完善居民医保制度时须着重调节筹资比例,使其与居民自付医疗费用比例下降相适配。

As an important part of China’s basic medical security system,Urban and Rural Resident Basic Medical Insurance(URRBMI)has accepted a lot of financial support from the government.The effect of URRBMI on residents’health status and medical burden needs to be discussed.From the view of the subsidy paid by government to URRBMI,we find that the number of complications for outpatients with special diseases has decreased significantly with the increase of national medical insurance subsidies for residents,while out-of-pocket medical expenditure has increased.The results suggest that the health status of residents has improved,while their medical burden is not lightened.Furthermore,according to the analysis of residents’utilization of medical services,we know that the results may be related to the residents transferring from outpatient to inpatient for higher medical insurance reimbursement.Therefore,in order to improve the resident medical insurance system in the future,we should pay more attention to the ratio of government subsidy and the proportion of residents’out-of-pocket medical expenditure.