| 引用本文：王乔.职工医保统筹层次提高对患者就医机构选择的影响[J].中国卫生政策研究,2023,16(9):36-43 |
|
| 职工医保统筹层次提高对患者就医机构选择的影响 |
| 投稿时间：2023-06-12 修订日期：2023-09-05 PDF全文浏览 HTML全文浏览 |
| 王乔 |
| 中南财经政法大学公共管理学院 湖北武汉 430073 |
| 摘要:提高医保统筹层次能扩大基金覆盖范围，但也可能会导致无序就医。本文基于中国家庭追踪调查数据(CFPS)，构建多时点双重差分模型，实证分析了职工医保统筹层次提高对患者就医机构选择的影响及其传导机制。研究发现：实施职工医保省级统筹会导致患者就医机构上移，且结果具有稳健性；对于高收入和健康的患者，职工医保省级统筹导致患者就医机构上移作用更明显，存在“穷人补贴富人”和“不健康患者补贴健康患者”的现象；影响机制分析发现，提高医保统筹层次使得报销比例提高和就医环境改善，导致患者就医机构上移，并且下级政府的道德风险纵容了患者就医机构上移。因此，在实施省级统筹的过程中，既要注意防范患者的道德风险，也要应对下级政府的道德风险，从而使得患者有序就医，实现医疗资源的合理配置。 |
| 关键词:医保统筹层次 就医机构选择 道德风险 逆向补贴 |
| 基金项目:国家社科基金一般项目(21BGL192) |
|
| The impact of the improvement of the employee medical insurance pooling level on the patients’ choice of medical institution |
| WANG Qiao |
| School of Public Administration, Zhongnan University of Economics and Law, Wuhan Hubei 430073, China |
| Abstract:Improving the overall level of medical insurance can expand the coverage of the fund, but it may also lead to disorderly medical treatment for patients.Based on the China Family Panel Survey (CFPS), this paper constructs a multi-temporal double difference model, and empirically analyzes the impact of the improvement of employee medical insurance coordination level on patients' choice of medical institutions and its transmission mechanism. The study finds that the implementation of the provincial-level coordination of employee medical insurance will lead to the upward movement of patients' medical institutions, and the results are robust; For high-income and healthy patients, the provincial-level coordination of employee medical insurance has led to a more significant upward shift in patient medical institutions, resulting in the unreasonable use of medical resources such as "poor people subsidizing the rich" and "unhealthy patients subsidizing healthy patients"; The analysis of the impact mechanism shows that the improvement of the level of medical insurance overall planning leads to the increase in the reimbursement ratio and the improvement in the medical environment, resulting in upward movement of patients' medical institutions, while the moral hazard of the lower-level government condones the upward movement of patients' medical institutions. Therefore, in the process of implementing provincial-level overall planning, attention should be paid to preventing patients' moral hazard, but also establishment of the medical insurance overall planning policy of power division and expenditure responsibility to deal with the moral hazard of the lower-level government, so as to provide patients with an orderly environment for medical care and realize the reasonable allocation of medical resources. |
| Key words:Medicare insurance pooling level Choice of medical institutions Moral hazard Reversed subsidy |
| 摘要点击次数: 585 全文下载次数: 390 |
|
|
