我国基本医疗保险住院服务受益公平性研究

发布时间：2018-05-26 16:34

本文选题：基本医疗保险制度 + 受益公平性　；参考：《中国卫生政策研究》2017年03期

【摘要】：目的:研究我国三种基本医疗保险制度下住院服务受益公平性问题。方法:利用中国家庭动态跟踪调查(CFPS)2010年基线调查数据,运用两部分模型来探讨不同制度下、不同收入水平的参保人群在医保覆盖的住院服务利用率和住院经济补偿两方面是否存在差异。结果:各收入组别在住院服务利用率方面差异不大;而在报销住院费用方面,较高收入组和最高收入组的医保报销费用分别比最低收入组高26.3%和36.5%。具体到每一制度,城镇职工医保不同收入组之间的报销费用不存在显著差异;城镇居民医保参保人员报销费用随收入水平的增加而呈现上升趋势;新农合制度只有最高收入组与最低收入组之间存在一定差异。结论:我国基本医疗保险在住院服务利用率方面不存在明显的不公平特征,但在医保报销水平上存在与收入相关的不公平特征。城镇职工医保的公平程度较高,新农合次之,而城镇居民医保受益公平性最差。从制度间的比较而言,新农合参合人员的住院率和医保报销费用均显著偏低。应积极推进基本医疗保险制度整合,加强医疗救助体系建设,完善大病保险制度,以改善制度公平性。
[Abstract]:Objective: to study the equity of inpatient service benefit under three basic medical insurance systems in China. Methods: using the data of Chinese Family dynamic tracking Survey (CFPS) 2010 baseline survey, using two-part model to explore the different systems, Whether there are differences in the utilization rate of hospitalization service and the economic compensation of hospitalization in different income groups. Results: there was no significant difference in the utilization rate of hospitalization services among the income groups, while in the reimbursement of hospitalization expenses, the reimbursement expenses of the higher income group and the highest income group were 26.3% and 36.5% higher than those of the lowest income group, respectively. To each system, there is no significant difference in reimbursement expenses among different income groups of urban workers, and the reimbursement costs of urban residents' medical insurance personnel show an upward trend with the increase of income level. There are only some differences between the highest income group and the lowest income group. Conclusion: there is no obvious unfair feature in the utilization ratio of hospitalization services in China's basic medical insurance, but there are some inequitable characteristics related to income in the level of medical insurance reimbursement. The fair degree of medical insurance for urban workers is higher, followed by NCMS, while the equity of urban residents' health insurance benefits is the worst. Compared with other systems, the hospitalization rate and medical reimbursement cost of NCMS participants were significantly lower. We should actively promote the integration of the basic medical insurance system, strengthen the construction of the medical assistance system, and improve the insurance system of serious illness so as to improve the fairness of the system.
【作者单位】：北京大学经济学院;
【基金】：国家社会科学基金重大项目(13&ZD042) 北京大学经济学院种子基金项目
【分类号】：R197.1;F842.684

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