医保预付制改革能否降低医疗费用:基于医疗要素投入的视角

Whether the Reform of Medical Insurance Pre-payment System can Reduce Medical Expenses:A Perspective Based on the Input of Medical Elements

文章基于医疗要素投入的视角,探究我国医保预付制改革对医疗费用产生的影响效果和作用机制。通过构建包含医生的效用函数理论模型,对后付制和预付制下医疗投入要素的均衡进行求解和比较,并利用医保局124577个参保住院患者的信息进行实证检验。研究结论显示,医保支付方式由后付制转变为预付制后,患者的住院总费用下降10.17%,患者的自费金额下降27.67%,住院天数下降36.82%。从某种意义来说,后付制下供方倾向于提供过度的医疗服务并造成医疗资源的浪费,而预付制改革提供使医疗服务数量回到社会最优水平的路径,即预付制改革显著降低患者的住院总费用,其作用机制对医疗服务供方形成正向激励,具体而言是通过重构医患之间的利益格局,进而改变医生的效用函数和行为模式。基于理论和实证结果,提出相应政策建议。

This paper explores the effect and acting mechanism of China's medical insurance pre-payment system reform on medical cost based on the perspective of medical element input.By constructing a utility function theory model including doctors the equilibrium of medical input elements under the post-payment system and the pre-payment system was solved and compared,and the information of 124577 insured inpatients in the medical insurance bureau was used for empirical test.The test concluded that after the payment mode of medical insurance was changed from the post-payment system to the pre-payment system,the total hospitalization cost of patients decreased by 10.17%,the out-of-pocket amount of patients decreased by 27.67%,and the number of days in hospital decreased by 36.82%.In a certain sense,providers under the post-payment system tend to provide excessive medical services,resulting in waste of medical resources,while the pre-payment system reform provides a path to make the quantity of medical services return to the optimal level of society,namely,the pre-payment system reform significantly reduces the total hospitalization cost of patients,and its acting mechanism is to form a positive incentive for medical service providers.Specifically,it changes the utility function and behavior mode of doctors by reconstructing the benefit pattern between doctors and patients.Corresponding policy recommendations are put forward based on theoretical and empirical results.