新型农村合作医疗逆向选择问题研究

发布时间：2018-03-20 00:32

本文选题：新型农村合作医疗　切入点：逆向选择　出处：《湖南农业大学》2015年硕士论文　论文类型：学位论文

【摘要】：新型农村合作医疗制度作为我国农村基本医疗保障制度,从2003年开始在全国推行,通过各级政府的积极推进、有效领导以及相互配合,经过十余年的发展,新型农村合作医疗制度的覆盖面不断扩大。2013年底,我国新型农村合作医疗制度参合人数达到8亿多人,补偿受益人次13.15亿,在该年的全国卫生工作总结会议上,卫生部部长陈竺同志提到,我国的新型农村合作医疗制度的参合率都维持在95%以上,筹资费用达到290元/人。新型农村合作医疗制度(以下简称“新农合”)基本实现全覆盖。尽管新农合制度的覆盖率与参合率一直不断攀升,但是新农合制度中仍然存在不少的问题,与保险市场中其他险种一样,逆向选择问题就是其中一个。逆向选择问题是指那些健康程度低的高风险者参合比例越来越高,相反健康程度高的低风险者占比例不断降低。逆向选择问题会增加医疗保险基金的筹集难度,阻碍了基本医疗保障制度的建立,这也影响着最终新农合在我国全面覆盖的真正实现,难以达到人人共享基本医疗服务的目标。因此,本文在针对新农合参合率突破95%的背景下,利用2012年中国劳动力动态调查(CLDS)数据,在介绍国内外逆向选择选择理论的基础上,对农户新农合的逆向选择问题进行实证研究。利用2012CLDS调查数据,首先,利用Logit模型从自感健康方面对新农合的逆向选择进行检验,为让结果更加稳健,再运用Probit模型从医疗服务利用方面再进行进一步论证。分别对我国的东部地区、中部地区及西部地区分别新农合的逆向选择问题进行实证性的检验。研究结果表明：在我国的东部、中部、西部地区,新农合制度中存在逆向选择问题。具体表现为：年龄越大、受教育程度越低、自感健康状况越差的农户更容易选择参合,并且参合者对医疗服务需求也比较高。提出应制定“柠檬定价”、加强医疗服务机构的管理等对策,避免逆向选择现象。
[Abstract]:The new rural cooperative medical care system, as the basic medical security system in rural areas of our country, has been implemented throughout the country since 2003. Through the active promotion, effective leadership and mutual cooperation of all levels of government, the new rural cooperative medical system has developed for more than 10 years. The coverage of the new rural cooperative medical system continues to expand. At the end of 2013, the number of participants in the new rural cooperative medical care system in China reached more than 800 million, and the number of compensation beneficiaries was one billion three hundred and fifteen million. At the National Health work Summary Conference of that year, Minister of Health Chen Zhu mentioned that the participation rate of China's new rural cooperative medical system is maintained at more than 95%. Funding costs reached 290 yuan per person. The new rural cooperative medical system (hereinafter referred to as "new rural cooperative medical system") basically achieved full coverage. Although the coverage and participation rate of the new rural cooperative medical system has been continuously rising, But there are still a lot of problems in the NCMS system. Like other types of insurance in the insurance market, adverse selection is one of them. The reverse selection problem refers to the increasing participation rate of those with low health and high risk. On the contrary, the proportion of people with high health and low risk is decreasing. The problem of adverse selection will make it more difficult to raise medical insurance fund and hinder the establishment of basic medical insurance system. This also affects the real realization of the overall coverage of NCMS in our country, and it is difficult to achieve the goal of sharing basic medical services for all. Therefore, this paper aims at the background of NCMS participation rate breaking through 95%. On the basis of introducing the theory of adverse selection at home and abroad, this paper makes an empirical study on the problem of adverse selection of farmers' new agricultural cooperation (NCMS) using CLDS data from 2012 China Labor Force Survey. Logit model is used to test the adverse selection of NCMS in terms of self-perceived health. In order to make the results more robust, the Probit model is used to further demonstrate the utilization of medical services. The research results show that in the eastern, central and western regions of our country, the reverse selection problem of the new agricultural cooperation is tested in the eastern, central and western regions of China, and the results are as follows: in the eastern, central and western regions of China, The problem of adverse selection exists in the new rural cooperative system. The more age, the lower the education level, the easier it is for the farmers with poor self-perceived health condition to choose to participate in the cooperation. The participants also have a high demand for medical services, and put forward some countermeasures, such as "lemon pricing", strengthening the management of medical service institutions, and avoiding adverse selection.
【学位授予单位】：湖南农业大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：F323.89;F842.684;R197.1

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