新型农村合作医疗制度对农户医疗负担的影响——基于供给者诱导需求视角的实证分析

The Effect of New Rural Cooperative Medical Scheme on Peasant Household Medical Expenditure——Based on the Empirical Analysis of the Perspective of the Supplier-induced Demand

为了考察新型农村合作医疗制度对农户住院医疗费用负担的影响,基于供给者诱导需求视角,利用2012年福建省400份农户入户随机调查数据,运用两部分模型进行实证分析。研究结果显示:(1)高科技医疗服务与设施利用、住院时间会显著增加农户的住院费用;(2)新农合支付方式改革对农户住院医疗费用负担影响不具有统计显著性;(3)新农合给付结构对农户医疗费用负担的影响并不一致,尽管年度补偿封顶线有效降低了农户医疗费用负担,但是报销比例却不能有效地约束医疗服务供给方和需求方的道德风险,从而不能有效降低医疗费用支出。研究结论对于如何有效控制医疗服务供给方的道德风险、抑制其诱导需求行为,真正减轻农户就医经济负担具有重要意义。由于受数据可得性的限制,本文没有考虑医院层级与地区医疗资源充足性等因素对农户医疗费用的影响。

Based on a random field survey of 400 famers in Fujian province in 2012,this paper applies the TWO-Part Model to examine the effect of New Rural Cooperative Medical Scheme(NCMS)on farm household inpatients' medical expenditure from the perspective of the supplier-induced demand.The empirical results show that:(1)The utilization of high-tech health care service and hospitalization time could significantly increase farm households' out of pocket hospitalization expenditure;(2) The factors such as medical information asymmetry and the reform of NCMS' payment method haven't significant effect on medical expenditure for farm household inpatients;(3)NCMS' co-payment mechanisms including reimbursement ratio and ceiling amount have different influence on farm households' medical expenditure:the reimbursement ratio couldn't control both physician and inpatients' moral hazard while the annual reimbursement ceiling amount effectively reduce farm households' inpatient expenditure.This has important policy implication on how to effectively regulate physicians' behaviors and control supplier-induced demand.Furthermore,it should be admitted that this paper does not take the effect of hospital hierarchy and medical resources distribution between different regions into consideration due to the availability of data.