| 引用本文：郝亚玮, 董朝晖, 卢岩, 孙利华, 程智涛.珠海市大病保险政策对不同医疗保险人群待遇差异的影响[J].中国卫生政策研究,2017,10(4):8-13 |
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| 珠海市大病保险政策对不同医疗保险人群待遇差异的影响 |
| 投稿时间：2017-01-15 修订日期：2017-02-19 PDF全文浏览 HTML全文浏览 |
| 郝亚玮1, 董朝晖2, 卢岩1, 孙利华1, 程智涛3 |
1. 沈阳药科大学工商管理学院 辽宁沈阳 110016;
2. 人力资源与社会保障部社会保障研究所 北京 100080;
3. 珠海市人力资源和社会保障局 广东珠海 519000 |
| 摘要:目的：分析珠海市大病保险政策实施情况，评估大病保险政策对职工医保和居民医保人群待遇差异的影响。方法：采用珠海市2012年、2014年医保患者的数据，对大病保险待遇获得情况进行描述性分析，采用逻辑回归模型分析影响大病保险待遇获得概率的因素，构建三重差分模型比较大病保险政策对职工医保和居民医保人群实际报销比差距的影响。结果：大病保险政策向高年龄段、高医疗费用段、有慢性病的医保人群倾斜；控制其他因素后，同一费用段患者中职工医保患者享受大病保险待遇的概率低于居民医保患者，前者为后者的58.1%。高费用段患者享受大病保险补偿后，尽管职工医保患者的实际报销比高于居民医保患者，但二者的实际报销比差距减小了3.2个百分点。结论：大病保险政策向高医疗费用段人群倾斜，提高了高医疗费用人群实际报销比，减小了居民医保人群和职工医保人群待遇的差距，促进了医疗保障公平性。 |
| 关键词:大病保险 医保待遇 公平性 |
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| The effects of catastrophic disease insurance policy on benefit discrepancy between the patients covered by different medical insurances in Zhuhai City, China |
| HAO Ya-wei1, DONG Zhao-hui2, LU Yan1, SUN Li-hua1, CHENG Zhi-tao3 |
1. School of Business Administration, Shenyang Pharmaceutical University, Shenyang Liaoning 110016, China;
2. Institute of Social Security Research, Ministry of Human Resources and Social Security, Beijing 100080, China;
3. Zhuhai Municipal Human Resources and Social Security Bureau, Zhuhai Guangdong 519000, China |
| Abstract:Objective: This study aims to analyze the effects of catastrophic disease insurance (CDI), especially to evaluate the influences of CDI on the discrepancy of benefits between the patients covered by the Employee's Medical Insurance (EMI) and the Resident's Medical Insurance (RMI). Methods: The data used in the study are collected from the health insurance database of Zhuhai City in the years of 2012 and 2014. A descriptive analysis is made to depict the general situation of CDI in the city, and a logistic regression model is used to analyze the factors that affect the probability to get the benefits of CDI. Moreover, a triple difference model is built up to probe into the CDI's effects on the discrepancy of reimbursement ratio between patients covered by EMI and RMI. Results: The benefits of CDI favor the patients with old age, high medical expenditures and chronic diseases. When other factors are controlled, patients covered by EMI have lower probability to get CDI benefits than those covered by RMI. Within the patients with high medical expenditures who have gotten the CDI benefits, those covered by EMI enjoy higher reimbursement ratio than those covered by RMI, but CDI decreases the discrepancy by 3.2%. Conclusions: Since the CDI gives more favor to the vulnerable population and narrows the gap of the benefits between EMI and RMI, the policy improves the equity of health security. |
| Key words:Catastrophic disease insurance Health insurance benefits Equity |
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