摘要
上世纪90年代初,我国开始实行了医疗个人帐户与社会统筹基金相结合的城镇职工基本医疗保险制度。学者大多认为,在医疗保险这种第三方支付机制下,患者和医生都对医疗服务价格不敏感,使得医疗费用不断升级。因此,怎样从供需双方来控制医疗费用的过快增长,从而更好地兼顾效益与公平,一直是医疗保险政策研究的热点。作为首批改革试点之一,镇江市基本医疗保险制度十多年来进行了多次政策调整,并逐步形成了“通道式”的管理模式。国内有关医疗个人账户的研究不少,但少有对“通道式”管理模式及医疗个人账户相关医疗保险政策调整如何影响医疗费用各部分支出的实证研究。
本文利用镇江平衡面板数据,构建数学模型,充分运用计量经济学中处理面板数据的固定效应模型、对内生变量进行处理的工具变量法、对二值因变量进行处理的Logit模型等回归分析方法,还使用了Hausman检验等方法以及一阶自回归校正方法,考察“通道式”管理模式下医疗个人账户的设置及政策调整是否能够以及如何影响不同年龄、不同社会经济特征职工的医疗费用的各部分支出(医疗个人账户支出、起付段支出、统筹段支出、医保基金支出以及年度总医疗费用),从而为医疗保险政策的完善和深化医药卫生体制改革提供科学依据。
通过对模型回归结果的分析发现,(1)医疗个人账户总量的增加,会使医疗个人账户支出额也有所增加,起付段支出额减少,一定程度上减少了统筹支出,同时使医保基金支出以及年度总费用均有少量增加;(2)降低医疗个人账户划入比例会显著减少医疗个人账户支出;(3)提高统筹段起付线,会减少各阶段的医疗费用支出;(4)缴费基数上涨带来医疗费用各部分支出都有所增加;(5)退休人员更容易进入统筹段,但进入统筹段后在职人员的医疗花费高。基于研究发现,本文最后对如何完善医疗个人账户以及更好地提高医疗个人账户的效率与公平提出了若干的政策建议。
The Urban Medical Insurance reform in China was initiated in the 1990’s, which combined with individual Medical Savings Accounts (MSA) and Social Pooling Accounts (SPA). It has several characteristics: high socialization degree, wide coverage, joint premium contributions by employers and employees, and some cost sharing mechanisms. Most scholars believe that medical insurance, as a third-party payment, is an important reason for the excessive growth of medical costs in modern society. Under this third-party payment mechanism, neither patients nor doctors are sensitive to prices and as a result escalates medical costs. Therefore, how to control the medical costs of medical insurance from both supply-side and demand-side has always been a hot research.
As one of the first pilot cities, Zhenjiang City adjusted the medical insurance policy for several times and gradually formed a management of "Channel–type‖. But Up to now, there have been quite a few empirical studies on how the "Channel-type" management style and medical insurance policy related to MSAs effect the medical expenditure
To examine whether and how the MSA of the basic medical insurance system under a―Channel-type‖management affects the medical expenditure of workers with different socio-economic characteristics, so as to provide a scientific foundation for the policy improving of the medical insurance and the deepen reform of health system.
Using a combination of quantitative and qualitative methods for the collection of "channel-style" medical insurance policy and information of the whole sample; quantifying the relationship between the MSAs and medical expenditure through regression analysis; applying econometrics methods such as fixed effect mode on a panel data, Instrumental Variable to deal with the endogenous variables, and the Logit model to analyze the binary dependent variables , as well as the test methods such as the Hausman test, and correction of first order autoregressive process.
The main findings are the following:
(1) Increased amount of MSAs would augment medical expenditure paid by MSAs, and decrease medical expenditure under the deductible line, the expenditure payed by SPA fund, the expenditure payed by medical insurance funds and the annual total medical expenditure. (2) Decreasing the proportion of fund into MSAs would reduce medical expenditure paid by MSAs. (3) Increasing the base payment would reduce medical expenditure in all the three stages. (4) Raising the deductible line would reduce medical expenditures from MSAs, expenditures below the deductible line and the co-ordination expenditure. (5) It was easier for retirees to enter the co-ordination, but the cost above co-ordinate of in-service personnel was higher.
Some policy implications are discussed at the end of the dissertation based on our research results.
引文
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