城乡居民医疗保险统筹、农村就医行为与消费支出

Unified Management of the Medical Insurance for Urban and Rural Residents,and Medical Treatment Behavior and Expenditure in Rural Areas

为实现“健康中国”的目标,中国基本医疗保险体系不断提高保障水平并扩大覆盖面,城乡居民基本医疗保险统筹便是对原新型农村合作医疗覆盖人群在医疗保险权益上的极大提升。利用城乡居民医疗保险统筹这一准实验及其在不同行政区推行的时间差异,通过多时点双重差分模型检验了医疗保险覆盖面扩大、报销比例上升对农村家庭就医行为与消费的影响。平均而言,城乡居民医疗保险统筹会使得农村家庭医疗支出增加11.6%、使家庭成员前往基层医疗机构就医的比例降低1.5%。随着时间的推移,统筹政策对医疗支出的刺激作用有所回落,但对就医选择的影响则持续性增强。异质性分析结果说明,受城乡居民医疗保险统筹政策影响更大的群体是无慢性病患者家庭和收入较低的纯农就业家庭,前者可能是由于除有慢性病患者家庭外,农村家庭的医疗需求未得到充分释放,而后者可能是因为低收入家庭的消费价格弹性与消费收入弹性更大。进一步研究发现,统筹政策对原城镇居民基本医疗保险覆盖群体无显著影响。

In order to achieve the goal of“Healthy China”,China’s basic medical insurance system has continuously improved the level of medical insurance and expanded its coverage.The unified management of basic medical insurance for urban and rural residents is a significant improvement in the medical insurance rights and benefits of the people covered by the former new rural cooperative medical system.Based on the quasi-experiment of the unified management of medical insurance for urban and rural residents and the time difference of its implementation in different administrative regions,this paper examines the impact of the expansion of medical insurance coverage and the increase in reimbursement rate on the medical treatment behavior and consumption of rural households through a multi-time difference-in-difference model.On average,the unified management of medical insurance for urban and rural residents has increased the medical expenditure of rural households by 11.6%and reduced the proportion of family members visiting primary medical institutions by 1.5%.Over time,the stimulating effect of the policy of unified management on medical expenditure has decreased,but the impact on the medical treatment choices increases continuously.The results of heterogeneity analysis suggest that the groups that are more affected by the policy of unified management of medical insurance for urban and rural residents are the households without chronic diseases and the low-income households with purely agricultural employment.The former may be due to the insufficient release of medical needs of rural households except for those with members suffering from chronic diseases,while the latter may be due to the greater flexibility of consumption price and income for consumption of low-income households.Further study shows that the policy of unified management has no significant effect on the original group that is covered by urban residents’basic medical insurance.