城乡医保整合对农村居民医疗服务利用的影响——以广州市为例

The Impact of Urban and Rural Medical Insurance Integration on the Utilization of Rural Residents’ Medical Service——A Case Study on Guangzhou

我国社会基本医疗保险体系存在着'碎片化'特征。不同医保制度在筹资方式、待遇水平以及管理方式上都存在着差别,导致了我国城乡居民医疗服务利用水平的差距较大。因而,社会基本医疗保险的整合在促进医疗服务利用、消除城乡差异、提高社会公平性等方面均有着重要的意义。本文使用2014年和2015年南沙区城乡居民医疗保险的就诊数据,通过采用双重差分法对医保整合的政策效应进行了回归分析。实证结果表明,实施城乡居民医保整合后,农村居民在医疗服务支出及就诊次数上均得到了有效的提升,但与城镇居民还存在较大差距。另外,城乡居民医疗服务的自付比例仍然较高,对于城乡居民来说有较大压力。最后,基于上述实证研究,本文对完善广州市社会医疗保险政策提出了几点建议。

The basic medical insurance systems in China are characterized by fragmentation.Different medical insurance systems have different features in terms of funding,benefit levels and management,which led to the gap between urban and rural residents on the utilization level of medical services.Therefore,the integration of the basic medical insurances is of great significance in promoting the utilization of medical services,eliminating urban and rural differences and improving social fairness.In this paper,the differencein-differences model is used to analyze the policy effect of medical insurance integration by using the clinic data of urban and rural residents’ medical insurance in Nansha District in 2014 and 2015.The empirical study argues that although the medical services expenditure and the number of visits of rural residents have significantly increased after the implementation of integrating the urban and rural residents’ medical insurances,there is still a big gap between rural and urban residents.In addition,the pay-out-of-pocket ratio of medical services by urban and rural residents is still relatively high,which imposes a big financial pressure on residents.Based on the above empirical study,this paper puts forward some suggestions on improving the social medical insurance policy of Guangzhou.