迁移对中老年人医疗费用支出的影响研究

The Impact of Migration on Medical Expenditures among Middle-aged and Older People

本文使用2018年中国健康与养老追踪调查数据研究迁移对中老年人医疗费用支出的影响。结果表明,无论是门诊治疗还是住院治疗,参保地和居住地不同的中老年人都有更少的医疗费用支出,这种差异不仅体现在医疗总费用上,也表现在报销之后的自付费用上。但是,对于过去一个月内有门诊治疗经历的人,以及过去一年内有住院治疗经历的人,迁移中老年人在就医过程中要支付更高的费用。机制分析表明,迁移中老年人在门诊和住院方面的就医行为更少,同时在就医中的报销比例也更低。最后,本文从持续推动基本医疗保险异地就医直接结算、建立全国统筹的医疗保险制度、加强对迁移中老年人的健康服务、提升健康治理水平等方面提出了政策建议。

This study examines the effects of migration on medical expenditures among middleaged and older people using data from the 2018 China Health and Retirement Longitudinal Study.The study revealed that middle-aged and older migrants had lower medical expenditures for both outpatient and inpatient care when their medical insurance coverage location differed from their residential location.This discrepancy is apparent not only in overall medical expenses but also in out-of-pocket costs after reimbursement.However,middle-aged and older migrants who received outpatient treatment in the previous month and inpatient treatment in the previous year tended to pay more for medical procedures.Mechanistic analysis indicated lower healthcare utilization and reimbursement rates among middle-aged and older migrants.Finally,this paper proposes policy recommendations,including the promotion of direct settlements of cross-provincial medical bills,the establishment of a nationally coordinated medical insurance system,strengthened health services for middle-aged and older migrants,and improved levels of health governance.