江西财经大学学报 ›› 2024, Vol. 0 ›› Issue (5): 53-65.

• 保险与保障 • 上一篇    下一篇

职工医保省级统筹对医保基金支出的影响及其作用机制研究

廖藏宜1, 石龙2   

  1. 1.中国政法大学 政治与公共管理学院,北京 100088;
    2.右江民族医学院 公共卫生与管理学院,广西 百色 533000
  • 收稿日期:2024-04-28 修回日期:2024-07-28 出版日期:2024-09-25 发布日期:2024-09-30
  • 通讯作者: 石龙,右江民族医学院讲师,管理学博士,主要从事医疗保险与卫生经济研究,联系方式gxshiong@163.com。
  • 作者简介:廖藏宜,中国政法大学副教授,管理学博士,主要从事医疗保险与健康治理研究。
  • 基金资助:
    国家自然科学基金项目“基于健康经济学评价的西南地区县域医共体医疗保险基金打包支付机制研究”(72164036)

Research on the Impact of Provincial Level Employee Medical Insurance Coordination on Medical Insurance Fund Expenditure and Its Mechanism

LIAO Zang-yi1, SHI Long2   

  1. 1. China University of Political Science and Law, Beijing 100088;
    2. Youjiang Medical University for Nationalities, Baise 533000, China
  • Received:2024-04-28 Revised:2024-07-28 Online:2024-09-25 Published:2024-09-30

摘要: 基于中国家庭追踪调查(CFPS)数据,采用固定效应模型估计职工医保省级统筹对医保基金支出的影响。研究发现,职工医保省级统筹显著提高了参保人医保基金支出水平,在运用倾向得分匹配法克服自选择问题后结论仍具有稳健性。分析表明,参保人更多地选择大医院就医和增加住院医疗服务利用是职工医保省级统筹扩大医保基金支出的重要渠道。异质性分析显示,职工医保省级统筹对低收入、农村地区和老年参保人群提高医保基金支出的作用更强。因此,在推进职工医保省级统筹的同时,应强化医保基金监管能力,构建医保基金风险评估和预警机制,确保医保基金支出的安全性。

关键词: 职工基本医疗保险, 省级统筹, 医保基金, 道德风险

Abstract: Based on the data of China Family Panel Studies (CFPS), this paper adopts a fixed effect model to estimate the impact of provincial pooling of employee medical insurance on medical insurance fund expenditures. The findings show that the provincial-level pooling of employee medical insurance has significantly improved the expenditure level of insured persons’ medical insurance funds, and this conclusion remains robust even after overcoming the self selection problems using the propensity score matching method. The analysis shows that the insured individuals are more likely to choose large hospitals for medical treatment and increase the utilization of inpatient medical services, which is an important channel for the provincial coordinated expansion of employee medical insurance fund expenditures. The heterogeneity analysis reveals that provincial pooling of employee medical insurance has a stronger effect on increasing medical insurance fund expenditures for the low-income, living-in-rural-areas, and elderly insured populations. Therefore, while promoting the provincial-level coordination of employee medical insurance, it is necessary to strengthen the supervision capacity of medical insurance funds, establish a risk assessment and early warning mechanism for medical insurance funds, and ensure the safety of medical insurance fund expenditures.

Key words: employees basic medical insurance, provincial level pooling, medical insurance fund, moral hazard

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