实物类转移支付的道德风险:以中国城职保个人账户为例

Moral Hazard in In-Kind Transfers:Evidence from Medical Savings Accounts in China

实物类转移支付限定用途的特点使接受者倾向于低估其价值,造成消费扭曲和效率损失。政府使用实物类转移支付进行收入再分配时需重点考虑这种道德风险产生的成本。本文以中国城镇职工基本医疗保险个人账户为例,基于中国西部某地级市2012-2016年2000多万条医疗保险报销大数据,运用动态双重差分法分析医疗保险个人账户的道德风险问题。估计结果显示,参保者在耗尽个人账户余额后,普通门诊和药店购药的费用和次数显著下降。这说明参保者会低估个人账户内资金价值,在个人账户余额耗尽后主观感觉医疗保健价格上升而减少医疗保健消费。因此,针对医疗保险个人账户的道德风险问题,政府有必要采取有力的改革措施,减少资金浪费。

In-kind transfers that are limited to spending on specific goods can lead beneficiaries to discount the value of funds,resulting in distorted consumption and efficiency losses.Such a moral hazard effect must be seriously taken into consideration when the government chooses to redistribute in kind,rather than in cash.Taking the medical savings accounts(MSAs)of the Urban Employee Basic Medical Insurance(UEBMI)in China as an example,and based on UEBMI administrative data(over 20 million)on a prefecture-level city in western China from 2012 and 2016,this paper employs dynamic difference-in-differences(DID)method to analyze moral hazard in MSAs.Results show a significant drop in expenses and visits on outpatient care and drugstore purchase after MSAs balances are depleted.This means that UEBMI enrollees in fact undervalue MSA funds and subjectively perceive higher healthcare prices after depleting their MSA balances,thereby reducing their healthcare consumption.This clearly indicates a moral hazard problem in MSAs and suggests that active reform measures are needed to reduce the misuse of funds.