基于两部模型的家庭医疗需求与消费结构研究

发布时间：2018-06-24 19:42

本文选题：两部模型 + 医疗保险制度　；参考：《厦门大学》2014年硕士论文

【摘要】：随着世界各国卫生费用的不断上涨以及医疗改革的不断推进,医疗保险制度通过降低就医的经济门槛,增加医疗保障服务的可及性,减轻居民家庭医疗费用的负担,释放消费需求,已在世界各地形成共识。目前,我国基本医疗保险体系已基本实现“全民医保”,并进入转变服务质量的重要改革阶段。本文引入两部模型来研究医疗保险对家庭住院医疗需求和家庭消费的作用,旨在提出有利于完善全民医保体系的政策性建议,进一步促进全民医保体系的效率与公平。首先,本文阐述了论文的选题背景、研究内容及论文框架。然后,本文以我国卫生医疗支出与全球卫生医疗支出的发展现状、我国居民医疗支出及其占消费支出比例的现状为背景,概括了我国全民医保体系的三个发展阶段。接着,本文梳理了国内外相关文献综述,引入用于分析全民医保体系下医疗服务利用的两部模型,基于厦门市居民家庭电话调查微观数据并利用两部模型及其扩展方法,来分别考察我国全民医保背景下居民家庭住院医疗需求和应对大笔医疗支出时家庭消费结构选择策略。从方法方面来看,在比较两部模型和广义线性模型的家庭住院医疗需求实证分析基础上,本文建立了由两部模型扩展而得的三部模型,并在大笔医疗支出下家庭消费结构选择实证分析中得到较好的拟合结果。从应用方面来看,以全民医保为背景,以家庭为单位,本文考察了家庭住院医疗需求两个决策过程的影响因素及其作用程度,并比较深入地分析了大笔医疗支出下家庭消费结构选择的时序决策过程及其影响因素。本文的实证研究主要得到以下几个结论：(1)全民医保体系确实对居民家庭基本生活及身体健康起到一定的保障作用,但基本医保对住院次数的医疗需求作用显著大于有慢性病患者,收入越高的家庭越有可能决定住院,基本医保所释放的新增医疗需求有可能是过度的、非有效的医疗消费；(2)住院次数多的家庭收入平均水平较低,有慢性病患者家庭的住院医疗需求更高,作为全民医保的兜底和补充部分,涵盖重特大病或慢性病的城乡医疗救助体系和大病补助医疗保险有着重要的推广意义；(3)在我国特有的城乡二元化背景下,农村家庭受大笔医疗支出的影响更大,并且,农村和城镇家庭在决定住院的医疗需求上没有显著差异,农村家庭对住院次数的医疗需求却显著高于城镇家庭,农村家庭在保障水平较低情况下还需要面对医疗效率问题。最后,本文进一步地总结了家庭住院医疗需求及消费结构选择实证研究的分析结果,对我国全民医保体系的效率和公平问题提出相关的政策性建议,并对未来进一步的研究进行了展望。
[Abstract]:With the rising of health costs and the promotion of health care reform in the world, the medical insurance system reduces the burden of medical expenses on households by lowering the economic threshold of medical treatment, increasing the accessibility of medical security services, and reducing the burden of medical expenses on households. The release of consumer demand has reached consensus around the world. At present, the basic medical insurance system of our country has basically realized "universal medical insurance" and entered the important reform stage of transforming service quality. This paper introduces two models to study the effect of medical insurance on family hospitalization medical needs and household consumption. The purpose of this paper is to put forward some policy suggestions that are conducive to the improvement of universal medical insurance system and to further promote the efficiency and fairness of universal medical insurance system. First of all, this paper describes the background of the topic, research content and the framework of the paper. Then, based on the status quo of health care expenditure in China and global health care expenditure, and the current situation of medical expenditure and its proportion in consumption expenditure, this paper summarizes the three stages of development of national health insurance system in China. Then, this article combs the domestic and foreign related literature review, introduces two models used to analyze the utilization of medical services under the universal health insurance system, based on the microscopic data of the household telephone survey in Xiamen, and uses the two models and their extended methods. To investigate the residents' hospitalization medical needs and household consumption structure selection strategies in the context of universal health insurance in China. From the point of view of method, on the basis of comparing the two models with the generalized linear model, this paper establishes a three-part model, which is extended by the two models. In the empirical analysis of household consumption structure selection under large medical expenditure, a good fitting result is obtained. From the aspect of application, taking the universal health insurance as the background and the family as the unit, this paper examines the influencing factors and the degree of action of the two decision-making processes of the family hospitalization medical needs. The decision process and its influencing factors of household consumption structure selection under large medical expenditure are analyzed in depth. The empirical study of this paper mainly draws the following conclusions: (1) the universal health insurance system does play a certain role in protecting the basic life and health of the residents. However, the effect of basic medical insurance on the number of hospitalizations is significantly greater than that of patients with chronic diseases, and the families with higher income are more likely to decide hospitalization, and the new medical needs released by basic medical insurance may be excessive and ineffective. (2) the average income of families with more frequent hospitalizations is lower, and families with chronic diseases have higher hospitalization medical needs, which is regarded as the bottom and supplementary part of universal health insurance. The urban and rural medical assistance system covering serious and serious diseases or chronic diseases and the medical insurance subsidy for major diseases have important significance in popularizing; (3) in the context of the dualization of urban and rural areas, rural households are more affected by large medical expenses, and, There is no significant difference between rural and urban families in determining the medical needs of hospitalization, but the medical demand of rural families is significantly higher than that of urban families, and rural families still have to face the problem of medical efficiency in the case of low security level. Finally, this paper further summarizes the results of the empirical study on the choice of family hospitalization medical needs and consumption structure, and puts forward relevant policy recommendations on the efficiency and fairness of the universal health care system in China. The future research is prospected.
【学位授予单位】：厦门大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.1;F842.684;F126.1

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