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医保支付方式在防范医疗服务供方道德风险、控制医疗费用不合理增长中具有重要的经济杠杆作用。本文利用样本地区医疗保险真实报销数据,运用双重差分法控制医疗需求释放、需方道德风险以及医疗服务价格调整等方面的影响,以探究医保支付方式对供方道德风险的影响及作用机理,结果表明:①在支付方式由"按诊次支付"改革为"按用药天数支付"后,参保人就诊频率显著降低,而次均医疗费用特别是中药费显著提高,使得总费用仍然维持在较高水平上。从而证明尽管按用药天数支付抑制了医疗服务供方"分解就诊次数"的道德风险,但却释放了"增加用药"的道德风险。②在不同的支付方式下,医疗服务供方会利用其专业知识和在医患信息不对称中所处的绝对优势地位,实现道德风险表现形式的转变,从而维护自身利益不受损害。③城乡居民医保参保人、65岁以上老年人、选择基层医疗机构就诊的患者、患有慢性病的病人受到的影响相对较大,说明医务人员"差别定价"行为也显著存在。本文的研究为医保支付方式的完善以及基金监管提供了有益的启示。
Abstract：Payment schemes of medical insurance have an important economic effect on preventing the moral hazard of medical service providers and controlling the unreasonable growth of medical expenses. With the real medical insurance reimbursement data from the sample area,this paper uses the DID method to eliminate the effects of medical demand release,moral hazard from the demand side,and the price adjustment of medical services,to explore the pure effect of payment schemes on the moral hazard of the medical service providers and its mechanism. The results show: first,after the payment scheme of the sample changes from "payment by visits"to "payment by days of medication",the frequency of medical visits of insured persons decreases significantly,while the average medical expenses per time,especially the Traditional Chinese Medicine,increase significantly,which leads to the total expenses keep as high as before. This finding confirms that under the payment scheme of"payment by days of medication",the moral hazard of decomposing the number of visits from medical service providers is under control,while the moral hazard of increasing medication is increasing.What's more,it is also indicated that under different payment schemes,medical service providers will make use of their absolute dominant position in the asymmetry of professional knowledge and patient information to realize the transformation of moral hazard,so as to safeguard their vested interests from being damaged.Finally,the patients with urban and rural residents' medical insurance,those aged over 65,the patients who choose to visit the primary care providers,and the patients with chronic diseases are relatively more affected,indicating that the behavior of "differentiated pricing"also exists significantly. The research in this paper provides enlightenment for the improvement of payment schemes and fund supervision.
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(1)数据来源:2012-2018年《中国统计年鉴》。
(1)数据来源:2013-2017年《人力资源和社会保障事业发展统计公报》; 2018年《全国基本医疗保障事业发展统计公报》。
(2)数据来源:《2018年医疗保障事业发展统计快报》。
(1)根据数据使用协定，本文不能透露样本地区具体的名称，在下文中一律用“A/B地区”代替。
(2)不同于自然年度，社保年度为当年的7月初到下一年的6月底。
(1)括号中为ICD10对应编码。
基本信息:
DOI：10.19343/j.cnki.11-1302/c.2020.08.005
中图分类号:R197.1;F842.684
引用信息:
[1]何文,申曙光.医保支付方式与医疗服务供方道德风险——基于医疗保险报销数据的经验分析[J].统计研究,2020,37(08):64-76.DOI:10.19343/j.cnki.11-1302/c.2020.08.005.
基金信息:
国家社会科学基金重大项目“预防为主的大健康格局与健康中国建设研究”(17ZDA080)
2020-08-25
2020-08-25
2020-08-25