我国基本医疗保险制度实施的亲贫效应研究

发布时间：2018-03-15 07:03

本文选题：基本医疗保险制度　切入点：城乡居民　出处：《南京大学》2014年博士论文　论文类型：学位论文

【摘要】：我国已形成了以城镇职工基本医疗保险、新型农村合作医疗以及城镇居民基本医疗保险这三项基本医疗保险为主体的多层次的医疗保障体系,为国民的健康改善发挥了保驾护航的作用。然而,当前的大多数研究仅仅能够说明基本医疗保险制度对健康及其相关因素的平均影响,而无法判断基本医疗保险制度是否改善了健康不平等。而从社会可持续发展以及制度可持续发展的角度讲,平等或公平的重要性甚至有时会大于效率的重要性。因此,本研究尝试运用相关研究方法,探讨我国基本医疗保险制度的实施对社会整体健康和就医指标分布形成的作用,从而为更加全面地分析我国基本医疗保险制度的实施效果提供新的证据。本研究首先通过宏观统计数据,考察了近年来基本医疗保险制度的发展和完善,随着全民覆盖的基本医疗保险制度的基本实现,越来越多的城乡居民从中得到实惠。同时,我国在国民健康领域也取得了举世瞩目的成就,包括以平均预期寿命、婴幼儿和孕产妇死亡率、甲乙类传染性疾病发病率和死亡率等指标表示的国民健康素质得到了显著改善。当然,我国在健康领域仍然存在着一些问题,最为显著的便是当前亟待解决健康不平等问题,该问题不仅表现在城乡之间,还表现在城乡内部；而我国城乡内部的健康不平等却较少被研究,本研究则希望从该方面切入,补充当前该领域研究的不足。本研究对健康和就医指标分布特征的考察,主要依托于集中指数和矫正的集中指数等评估方法,并根据其取值特征,判断其分布是否“亲贫”；而对健康和就医指标分布变化的考察,则主要依托于增长发生曲线,以及相关指标的比较,从而判断其是否发生了“亲贫式增长”。增长发生曲线本身衡量了健康和就医指标分布的跨期变化是否存在弱绝对亲贫倾向,而与平均增长率的结合,则衡量了相关指标是否发生了相对意义上的亲贫式增长。“亲贫”主要是从静态角度进行判断,而“亲贫式增长”则主要从动态角度进行判断。通过中国家庭营养健康调查数据库2000年以来的调研数据,运用相关评估方法,本研究分别以城乡居民整体、城镇居民和农村居民为研究对象,以家庭为单位,讨论了其健康和就医指标分布的特点及其变化。相关分析表明,四周未患病状况、四周就诊状况和无慢性病状况等主要表现出亲贫的分布特征；自评健康水平、门诊费用和门诊报销比例等的分布则主要表现为亲富性。考察指标的相邻年份样本的比较结果显示,这些指标的弱绝对亲贫式增长尚未发生,但在亲贫区间较为适宜时,这些指标大多可以得出相对意义上亲贫式增长的结论。然而,健康和就医指标的“亲贫”或“亲贫式增长”,只是从侧面反映了我国基本医疗保险制度在其中可能起到了促进亲贫的作用,而实际情况如何,还需要结合参加基本医疗保险对健康和就医的促进／抑制作用以及参加基本医疗保险本身的亲贫／亲富分布特征。通过运用线性回归及矫正的集中指数的相关分解方法,本研究分别以城乡居民整体、城镇居民和农村居民为考察样本,以个体为单位,分析了基本医疗保险对健康和就医指标分布形成的贡献。结果表明,在多数情况下,基本医疗保险对四周未患病和四周就诊等指标分布的形成具有亲贫效应,确实起到强化健康和就医指标亲贫性分布特征或弱化其亲富性分布特征的效果。鉴于我国基本医疗保险仍在进行制度创新以更好地保障参保者的健康权益,本研究还根据江苏实施和未实施大病保险地区的实地调研数据,分析了大病保险对健康的促进作用,以及大病保险地区的健康的亲贫与亲贫式增长的特征。结果表明,城乡居民大病保险显著提高了城乡居民的自评健康水平；并且,就实施大病保险地区的健康指标分布而言,其亲贫和亲贫式增长的特点较为明显。最终,根据上述结论,为促进我国基本医疗保险制度的亲贫性,本研究提出了相关政策建议。
[Abstract]:China has formed a basic medical insurance for urban workers, the new rural cooperative medical care and basic medical insurance for urban residents of the three basic medical insurance as the main body of the multi-level medical security system, has played the role of escort for the improvement of national health. However, when most before the study can only show that the average effect of basic medical the health insurance system and its related factors, and to determine the basic medical insurance system is to improve the health inequality. From the social system of sustainable development and sustainable development perspective, the importance of equality and fairness, and sometimes even greater than the importance of efficiency. Therefore, this study attempts to use the related research methods, explore the implementation of basic medical insurance our system of medical index distribution on the role of the formation of the whole society and health, which is a more comprehensive analysis of China's basic Provide new evidence for the effectiveness of medical insurance system. This study firstly investigated the macro statistics, in recent years the development of the basic medical insurance system and perfect, with the basic realization of the basic medical insurance system of universal coverage, more and more rural residents benefit from. At the same time, China has also made remarkable achievements in the national health field, including life expectancy, infant and maternal mortality, said the index of class A and B infectious disease morbidity and mortality of the national health quality has been improved significantly. However, in our country there are still some problems in the field of health, the most significant is the current urgent health inequalities. This problem not only in between urban and rural areas, but also in rural and urban and rural areas in China; internal health inequality was less studied, this research hope From the perspective, to supplement the current research in this field. This study examined the distribution of the health and medical indicators, mainly relying on the concentration index and the correction of the concentration index evaluation method, and according to the characteristics of the distribution of value judgment, whether the "Pro poor"; while the indexes of the change in the distribution of medical and health then, mainly relying on the growth curve, and compared the related indicators, in order to determine whether the occurrence of the "Pro poor growth. Growth curve itself to measure the health and medical intertemporal variation index distribution of the existence of weak absolute Pro poor tendency, combined with the average growth rate, is a measure of relevant indicators have a relative sense of Pro poor growth." Pro poor "is mainly judged from the static angle, while the" Pro poor growth is mainly from the dynamic point of judgment. Through the China family camp The survey data since the 2000 health survey database, using the relevant evaluation method, in this paper the overall urban and rural residents, urban residents and rural residents as the research object, the family unit, discusses its health and medical characteristics and distribution index. Correlation analysis showed that the prevalence is not around, around the treatment status and the situation of the chronic diseases mainly shows the distribution of Pro poor; self rated health level, the distribution of outpatient and outpatient reimbursement etc. mainly. The indexes of Pro rich samples compared with the adjacent years showed that these indicators weak absolute Pro poor growth has not yet occurred, but in the pro poor interval suitable, most of these indicators can be obtained relative sense of Pro poor growth results. However, the medical and health index of "Pro poor" or "Pro poor growth", only from the side back Reflects China's basic medical insurance system in which may play a role in promoting Pro poor, and how the actual situation, combined with the need to participate in the basic medical insurance for medical treatment and health promotion / inhibition and participate in the basic medical insurance is pro poor / Pro rich distribution. By using the linear concentration index decomposition method regression and correction, in this paper the overall urban and rural residents, urban residents and rural residents as the study sample, with the individual as a unit, analysis of the basic medical insurance for medical treatment index's contribution to the health and distribution. The results show that in most cases, the basic medical insurance has Pro poor effect on the formation and distribution of four in and around the hospital and other indicators, indeed to strengthen health and medical indicators of Pro poor distribution or weaken its pro rich distribution of effect. In view of China's basic medical Insurance is still in the system innovation in order to better protect the insured's rights to health. This study also according to the Jiangsu implementation and field survey data of serious illness insurance area implementation, analysis of a serious illness insurance on health promotion and health insurance area of Pro poor and pro poor growth characteristics. The results show that the illness the insurance of urban and rural residents to significantly improve the self-rated health level of urban and rural residents; and, on the implementation of serious illness insurance area health index distribution, the pro poor and pro poor growth characteristics are obvious. Finally, according to the above conclusions, to promote Pro poor basic medical insurance system in China, this study puts forward related policy advice.

【学位授予单位】：南京大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R197.1;F842.684

【参考文献】