城镇医疗保障制度对城镇贫困居民就医经济负担的影响——基于霸州、赤壁和合川城镇贫困家庭调查数据的分析

文章基于对河北省霸州市、湖北省赤壁市和重庆市合川区三个县级行政区域城镇贫困居民的抽样调查,考察了城镇医疗保障制度降低贫困居民就医经济负担的效果。研究结果表明,城镇居民基本医疗保险和医疗救助的实施在一定程度上减轻了贫困居民的就医经济负担,但由于城镇医疗保障制度实际报销比例偏低、贫困居民对医疗费用的承担能力有限以及大量贫困居民存在灾难性医疗支出,他们的就医经济负担仍然较重;在住院治疗中,降低城镇居民基本医疗保险和医疗救助的起付线、提高报销比例、简化报销程序等措施能够有效降低城镇贫困居民的就医经济负担。     

均等下的不公——城镇居民基本医疗保险受益公平性的理论与实证研究

坚持公平是国家医药卫生体制改革的基本原则之一。本文评估了覆盖2.5亿城镇人口的城镇居民基本医疗保险参保个人受益的公平性。理论模型显示,对于政府提供的均等化基本医疗保险,高收入参保人群的受益超过低收入人群。我们利用2007—2011年"国务院城镇居民基本医疗保险试点评估调查"数据,通过两部模型(Two Part Model)等方法对城镇居民基本医疗保险参保个人的受益公平性进行分析,结果与理论模型分析结论保持一致。本文的基本判断是:均等化补偿制度下的基本医疗保险将造成低收入参保人受益的劣势,且由于低收入人群健康水平更差,这样的制度设计将加剧健康的不公平。本研究将为进一步完善中国基本医疗保险制度提供决策参考依据。     

对医疗保险重复参保问题的探讨

目前我国已建立了城镇职工医疗保险、城镇居民医疗保险、新型农村合作医疗保险等覆盖全民的基本医疗保险体系,从而实现了居民"病有所医"。但由于我国的基本医保制度分设、管理分割、资源分散,使得医保管理体制当中居民重复参保问题日益突出,对我们当前的基本医疗保险制度的健全和发展提出了巨大的挑战。本文通过分析问题发生的原因,探索解决居民重复参保问题的措施。     

健康冲击:现行医疗保险制度究竟发挥了什么作用?

在进一步深化医疗改革的行动中,人们关注的焦点问题是,现行医疗保险制度在应对居民遭遇疾病冲击时究竟发挥了多大作用?本文利用大型微观数据研究了医疗保险制度对居民住院医疗服务利用和经济负担的影响。研究结果显示,医疗保险人群的住院可及性明显高于非医保人群,同时医药总费用也明显较高。然而医保人群的自付医药费用仍然显著低于非医保人群,自付医药费用占家庭年收入的比重也更低。医疗保险制度对减轻老年人群和慢性病人群的医疗经济负担具有显著作用。公费医疗和城职保在降低医疗负担上的作用明显高于其他保险形式。由此得到的基本结论是,现行医疗保险制度提高了医保人群的医疗服务利用水平,显著减轻了其医疗经济负担,并且更多惠及了慢性病、老年人群;未来制度的完善需要重点考虑如何惠及低收入和外地户口人群。     

城镇基本医疗保险中逆向选择的检验

本文利用城镇居民基本医疗保险试点评估调查的数据,实证检验了我国城镇居民和职工基本医疗保险中的逆向选择问题。本文的实证结果证实了逆向选择的存在:在未被城镇职工基本医疗保险覆盖的城镇人群中,健康状况较差的个体更倾向于参加城镇居民基本医疗;城镇居民基本医疗保险的参保者接受门诊和住院服务利用率的概率更高;保险对住院服务利用率的影响大于对门诊的影响。另一方面,我们还发现在已被城镇职工基本医疗保险覆盖的人群中,健康状况较差的职工也更倾向于购买补充商业医保,但是健康状况最差的个体购买补充商业医保的概率最低,而购买商业医保后住院率显著增加。     

城镇基本医疗保险中逆向选择的检验

本文利用城镇居民基本医疗保险试点评估调查的数据,实证检验了我国城镇居民和职工基本医疗保险中的逆向选择问题。本文的实证结果证实了逆向选择的存在:在未被城镇职工基本医疗保险覆盖的城镇人群中,健康状况较差的个体更倾向于参加城镇居民基本医疗;城镇居民基本医疗保险的参保者接受门诊和住院服务利用率的概率更高;保险对住院服务利用率的影响大于对门诊的影响。另一方面,我们还发现在已被城镇职工基本医疗保险覆盖的人群中,健康状况较差的职工也更倾向于购买补充商业医保,但是健康状况最差的个体购买补充商业医保的概率最低,而购买商业医保后住院率显著增加。     

全民医保:离我们还有多远——国家医疗卫生体制改革专家关志强谈全民医保

4月4日,国务院决定启动以大病统筹为主的城镇居民基本医疗保险试点工作,广覆盖的"全民医保"时代即将到来.在中国"全民医保"到底需要多少钱?政府、居民各应承担哪些责任和义务,未来的改革应以什么为目标?劳动和社会保障部社会保障研究所医疗保险室主任、国家医疗卫生体制改革专家关志强阐述了自己的观点.     

城镇居民医疗保险对卫生服务利用的影响——政策效应与稳健性检验

基于国家基本医疗保险调查数据,运用面板随机Probit模型,研究发现,城镇居民医疗保险显著促进了居民基本卫生服务利用,政策实施效果良好。而且,其对卫生服务利用的影响具有全面和分层次促进的特点:城镇居民医疗保险促进了全体居民进行健康体检,促进了弱势群体的门诊服务利用,显著提升了低健康群体的住院服务利用。城镇居民医疗保险制度促进了低健康群体卫生服务利用的合理增长,中高健康群体未出现过度利用医疗资源的问题,制度较好地兼顾了公平与效率。促进保健、自我诊疗与门诊利用是未来城镇居民医疗保险制度完善的优先投入方向。     

基本医疗保险资金审计管见

城镇职工基本医疗保险、新型农村合作医疗和城镇居民基本医疗保险是基本医疗保险的重要组成部分,基本医疗保险是社会保障的重要组成部分.本文主要研究基本医疗保险资金审计需关注的重点,分析了医疗保险制度执行及资金筹集、使用、管理中可能存在的问题及成因,提出了对策及建议.     

城镇居民基本医疗保险适度缴费率分析

城镇居民基本医疗保险缴费率是指把城镇居民纳入基本医疗保险体系后,从社会平均水平看,在一定时期内(通常为一个月)各参与主体为城镇居民所缴纳的基本医疗保险费占工资的比重。通过构建城镇居民基本医疗保险适度缴费率模型,根据模型对城镇居民基本医疗保险适度缴费率进行测算,对现行城镇居民基本医疗保险实际缴费率的适度状况进行了判断,并提出相应的策略选择。     

Does health insurance matter? Evidence from China’s urban resident basic medical insurance

In 2007, China launched a subsidized voluntary public health insurance program, the Urban Resident Basic Medical Insurance (URBMI), for urban residents without formal employment. We estimate the impact of the URBMI on health care utilization and expenditure by a fixed effects approach with instrumental variable correction, using the 2006 and 2009 waves of the China Health and Nutrition Survey. We explore the time variation of program implementation at the city level as the instrument for individual enrollment. We find that this program has significantly increased the utilization of formal medical services, including both outpatient care and inpatient care, but it has not reduced total out-of-pocket health expense. We also find that this program has improved medical care utilization more for children, members of the low-income families, and the residents in the relatively poor western region.     

Does non-employment based health insurance promote entrepreneurship? Evidence from a policy experiment in China

Previous researchers have shown that employment-based health insurance lowers job mobility and deters entrepreneurship. The Urban Resident Basic Medical Insurance (URBMI) program, piloted in 2007 in China and fully established in 2009, offers health insurance to about 271 million urban residents without formal employment. Before the implementation of URBMI, most urban residents obtained health insurance through their employers, and therefore a large number of unemployed and self-employed individuals were uninsured. Thus, URBMI creates a new insurance option that does not depend on formal employment and may promote entrepreneurship. We take advantage of this policy change to evaluate the effect of URBMI on self-employment. Using 2000–2011 data from the China Health and Nutrition Survey and a difference-in-differences approach with propensity score weighting, we found that URBMI increased self-employment rate by at least 8.73% for the overall population. The result was mainly driven by the URBMI’s impact on unhealthy workers, individuals with 12 years of schooling or less, and workers above 30 years old.     

The effect of non-employment-based health insurance program on firm's offering of health insurance: Evidence from the social health insurance system in China

To achieve universal health insurance coverage, many developing countries have established a segmented health insurance system, which contains separate programs for workers with formal employment and residents without formal employment. A potential concern with such a segmented system is that the establishment of a non-employment-based insurance program may generate a disincentive for firms to provide health insurance benefits to workers. In this study, we empirically examine this crowd-out effect of a non-employment-based insurance program, the Urban Residents Basic Medical Insurance (URBMI), in China. Exploiting city-by-year variations in the roll-out process of the program and utilizing a unique administrative dataset on Chinese firms, we find that the enactment of URBMI reduced a firm's offering of an employment-based health insurance program by a statistically significant 0.94-1.29 percentage point. This crowd-out effect was stronger among domestic private firms, new firms, and firms that are individual-owned.     

天津市城镇职工基本医疗保险住院患者医疗费用因子分析

目的:探寻住院医疗费用的影响因素,为合理配置公共卫生资源、有效控制医疗费用提供参考和借鉴。方法:以天津市2007年城镇职工医疗保险10%的住院患者为样本,使用SPSS18.0进行因子分析。结果:药品治疗检查费因子、手术相关费用因子及成分输血因子是影响住院医疗费用的三个支配因子。结论:控制城镇职工医疗保险住院医疗费用过度增长,应着力控制药品费和医用材料费。     

中国城镇社会医疗保障改革的理论探索

With its transition to a market-oriented economy, China has gone through significant changes in health care delivery and financing systems in the last three decades. Since 1998, a new public health insurance program for urban employees, called Basic Medical Insurance Program (BMI), has been established. One theme of this reform was to control medical service over-consumption with new cost containment methods. This paper attempts to evaluate the effects of the reformed public health insurance on health care utilization, with in-depth theoretical investigation. We formulate a health care demand model based on the structure of health care delivery and health insurance systems in China. It is assumed in the model that physicians have pure monopoly power in determining patients’ health care utilization. The major inference is that the insurance co-payment mechanism cannot reduce medical service over-utilization effectively without any efforts to control physicians’ behavior. Meanwhile, we use the calibrated simulation to demonstrate our hypothesis in the theoretical model. The main implication is that physicians’ incentive to over utilize medical services for their own benefits is significant and severe in China.      

社会医疗保障改革的福利效应:以中国城镇为例

This paper evaluates Chinese public health insurance reform enforced since 1998 in terms of its welfare effects. We evaluate China health insurance reform since 1998 using the China Health and Nutrition Surveys (CHNS) data with relevant econometric models. The results of empirical studies show that the public health insurance status has significant impact on medical service utilization and expenditure. The reform reduces the positive effect of public health insurance on medical service utilization, meaning the utilization gap is narrowed after the reform. However, the empirical studies find that the medical expenditure growth of the sample individuals in urban China has not been controlled after the Basic Medical Insurance (BMI) program even if a new co-payment is enforced. Two main reasons for this failure might be the rising cost of medical service and physician’s severe moral hazard, while both of them come from no managed care mechanism for medical service providers in China.      

居民医疗机构选择行为的影响因素分析——以沈阳市为例

借助CATI调查获得798份有效样本,应用SPSS18.0、LISEL8.8和Mplus5.2等统计软件检验问卷质量与效度,通过构建居民医疗机构选择行为模型来分析影响居民选择不同级别医疗机构的因素。影响居民选择一级定点和非定点医疗机构的最主要因素是"就医方便性",影响居民选择三级定点和非定点医疗机构的最主要因素是"感知医疗服务质量",影响居民选择二级定点医疗机构选择最主要的因素是"医疗保险满意度",而影响其选择二级非定点医疗机构选择的最重要因素则是"就医社会网络"。     

城镇居民基本医疗保险的比较制度分析——基于东、中、西部3省9市试点方案的比较

分析了浙江、湖北、陕西3省9市城镇居民基本医疗保险制度在参保范围等九个方面的异同点,基于制度比较的视角考察了不同制度安排的绩效。城居医保政策设计必须坚持"统一制度框架与分散决策相结合"的原则,将制度的自然演进和人为设计有机地结合起来。     

城镇职工基本医疗保险分散大病风险研究——基于广东典型地区的分析

选取广东省三个代表性地区的大规模医疗保险数据,对职工医保分散大病风险的效果进行了定量分析和模拟测算。从总体上看,参保人的医疗负担还比较重;职工医保在缓解灾难性支出方面作用明显,但整体效果有限。在40%的门槛下,欠发达地区灾难性支出发生率达到29.3%,发达地区也达到了8.5%。相对弱势的中老年群体和低收入群体是灾难性支出发生率最高的群体,但并未受到职工医保的充分照顾。相反,20-39岁的年青群体和高收入阶层成为相对受益最大的群体。从保障水平调整机制、补充医疗保障体系以及医疗救助与职工医保的衔接等三个方面提出了政策建议。