医疗保险异地就医直接结算对居民健康的影响研究

医疗保险异地就医直接结算对居民健康的影响研究

The Effect of Direct Settlement of Medical Insurance for Nonlocal Medical Treatment on Residents’ Health

《财经研究》2023年49卷第6期 页码：94 - 108 online：2023年6月3日

作者

中：高娜娜1 , 胡宏兵2 , 刘奥龙1

英：Gao Nana1, Hu Hongbing2, Liu Aolong1

作者单位：1. 河南大学 经济学院，河南 开封 475004; 2. 中南财经政法大学 金融学院，湖北 武汉 430073

摘要及关键词

摘要：持续推进医保权益和医疗服务的公平性和可及性是推进“健康中国”战略实施和实现共同富裕的内在要求。文章采用CHARLS数据和双重差分模型检验了医疗保险异地就医直接结算对居民健康的影响。研究发现，异地就医直接结算显著提升了居民的自评健康。但该政策的健康效应对农村居民、新农合参保居民、低教育程度居民和低收入水平居民的影响更显著，其提升了弱势群体的健康水平，缩小了不同群体之间的健康差距。机制分析表明，异地就医直接结算通过提升参保居民医疗资源利用、降低医疗费用负担、释放医疗服务需求、增加家庭消费支出和改变家庭消费结构来影响其健康。为了实现更高水平的全民健康，需要继续深化医疗保障制度改革，加大基本医疗保险统筹力度，稳步提高医疗保险待遇水平，并且推动医疗健康资源向弱势群体倾斜。

关键词：共同富裕；医疗保险基本公共服务均等化；异地就医直接结算；健康

Summary: Continuously promoting the equity and accessibility of medical insurance rights and medical services is an inherent requirement for promoting the implementation of the Healthy China Strategy and achieving common prosperity. In order to solve the problem of difficulty in reimbursement of medical expenses for nonlocal medical treatment, since the New Medical Reform in 2009, China has begun to promote the policy of direct settlement of medical insurance for nonlocal medical treatment. However, at present, there is relatively little literature on the evaluation of the effect of direct settlement policy. Based on the quasi-natural experiment of the direct settlement for intra-provincial medical treatment, this paper uses CHARLS data and DID model to empirically evaluate the health effect of direct settlement of medical insurance for nonlocal medical treatment, analyzes whether the policy is more beneficial to vulnerable groups, and discusses the mechanism of the policy to improve residents’ health level from the perspectives of medical treatment behavior, medical expenses and family consumption upgrading. The results show that: First, the policy has a significant effect on the health of insured residents. Second, the policy has a more significant impact on the health of rural residents, new rural cooperative medical insurance insured residents, low-education residents and low-income residents, and it improves the health level of vulnerable groups. Third, the policy affects the health of insured residents by improving the utilization of medical resources, reducing the burden of medical expenses, releasing the demand for medical services, increasing household consumption expenditure and changing the household consumption structure. Therefore, it is necessary to continue to deepen the reform of the medical security system, improve the overall pooling level of basic medical insurance, steadily improve the level of medical insurance benefits, and promote medical and health resources to favor vulnerable groups. The possible marginal contributions of this paper are that: First, it enriches the literature on the evaluation of the effect of the policy from the perspective of health. Second, it explores the heterogeneity of the health effect of the policy from different dimensions, providing a useful reference for further promoting the reform of the equalization of medical insurance benefits. Third, it examines the medical behavior mechanism, medical expense mechanism, and consumption upgrading mechanism, providing a theoretical basis for how the equalization of basic public services in medical insurance can promote the health of the whole population.

Key words: common prosperity; equalization of basic public services in medical insurance; the policy of direct settlement for nonlocal medical treatment; health

其他信息

DOI：10.16538/j.cnki.jfe.20230316.402

收稿日期：2022-11-07

基金项目：国家社会科学基金一般项目（22BJY217）

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