通讯作者: 王乔, 3242747636@qq.com

DOI：10.12201/bmr.202310.00006

Effects of Medicare Insurance Pooling Reform for Employees on The Choice of Medical Institutions for Patients

• 摘要：医保统筹层次提高能扩大基金覆盖范围,但也可能会导致无序就医。本文基于2010-2020年中国家庭追踪调查数据(CFPS)五期面板数据,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; ; ; 

   

  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 five phase panel data of the China Family Follow up Survey (CFPS) from 2010 to 2020, this paper constructs a multi time point double difference model, and empirically analyzes the impact of the improvement of the overall level of employee medical insurance on patients choice of medical institutions and its transmission mechanism. The study found that the implementation of the provincial medical insurance plan for employees would lead to the upward movement of patients medical institutions, which is robustness; 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 subsidize the rich and unhealthy patients subsidize healthy patients; The analysis of the impact mechanism found that the improvement of the level of medical insurance overall planning led to the increase of the reimbursement ratio and the improvement of the medical environment, which led to the upward movement of patients medical institutions, while the moral hazard of the lower level government connived at the upward movement of patients medical institutions. Therefore, in the process of implementing the provincial overall planning, we should not only pay attention to preventing patients moral hazard, but also establish 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 enable patients to seek medical care in an orderly manner and realize the reasonable allocation of medical resources.

  Key words: Medicare Insurance Pooling; Selection of Medical Institutions; Moral Hazard; Reverse Subsidy

  提交时间：2023-10-23

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2023-06-12	bmr.202310.00006V1	下载

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