医疗救助与医疗保险制度衔接探讨

我国医疗保险主要包括城镇职工基本医疗保险、城镇居民基本医疗保险和新型农村合作医疗,另外还有公费医疗、企业补充医疗保险、商业医疗保险等.目前,我国医疗保险制度尚未覆盖所有人群.据资料显示[1],城镇职工2.7亿,参保1.8亿;城镇非从业居民2.4亿,参保0.3亿;农村居民中参加新型农村合作医疗的人数2008年达到8.33亿,参合率在90%以上,但保障水平较低[2].在参保和非参保人群中,均有贫困人群,有的要么一开始就贫困,有的或者因某些因素而变得贫困,如疾病、灾害等.这些人群可能因为持续贫困或因某些因素陷入贫困,而无法参加保险或者退出保险.由于没有医疗保险的保障,这些人一旦面临大额医疗费用,将陷入更严重的贫病循环.     

中国儿童医疗保障的家庭依赖度研究——以4180个样本为例

在全民医保制度框架下,中国儿童实际医疗保障的家庭依赖度及其影响因素值得深究.以儿童实际医疗费用自付比来测量家庭依赖度,发现大多数儿童具有75％以上的高依赖度,有些甚至是完全自付;参保类型、享有医疗保险种数、有否商业医疗保险、是否因病住院、就医次数、是否农业户口和家庭人均纯收入等因素影响家庭依赖度,其中是否因病住院和享受...     

普惠型补充医疗保险续保意愿及其影响因素研究*

目的：从个体行为角度探索普惠型补充医疗保险的续保问题及其影响因素。方法：利用来自17229名普惠型补充医疗保险参保人的调查数据,基于安德森模型框架,研究参保人续保意愿的影响因素。结果：81.44%的被调查参保人愿意续保;对产品服务感知、是否享受过赔付是影响续保意愿的重要因素。结论：参保人对产品服务感知是影响普惠型补充医疗保险续保意愿的核心因素,完善配套健康服务功能迫在眉睫。普惠型补充医疗保险与传统商业健康保险并没有相互挤占,在基本医疗保险与商业健康保险之间形成有效衔接,共同服务于多层次医疗保障体系的完善。     

商业医疗保险参保的供给影响因素研究——基于CGSS2013数据的实证分析

运用Prebit模型分析CGSS2013家户微观数据和保险供给宏观数据,探究影响商业医疗保险参保的因素,发现供给不足制约居民参保,对西部、中部和农村地区影响显著。家庭财富不足、保险知识缺乏、基本医疗保险也影响居民参保。主张推动保险供给侧结构性改革,保险公司增设分支机构,补齐供给短板。政府增加农民收入,普及保险知识,提供有限保障。     

商业医疗保险对家庭因病支出型贫困的影响——基于CGSS数据的实证分析

[目的]验证商业医疗保险对于抑制因病支出型贫困的效果，为发挥商业医疗保险在多层次医疗保障体系中的作用提供依据。[方法]利用2018年中国综合社会调查数据(CGSS),采用倾向得分匹配法(PSM)实证检验商业医疗保险对于因病支出型贫困的影响，并进一步探究其作用机制。[结果]家庭购买商业医疗保险可以显著抑制因病支出型贫困的发生，购买商业医疗保险家庭的因病支出型贫困发生概率较未购买家庭降低了4.1%。[结论]商业医疗保险可通过增加家庭健康人力资本、教育人力资本、金融资本和社会资本存量，进而抑制因病支出型贫困的发生，且对于缓解高保险深度地区和农业户籍人群的因病支出型频率发生作用更加明显。     

慢性病患者健康贫困脆弱性的影响因素研究

目的:通过健康贫困脆弱性的研究识别慢性病患者中的高脆弱性群体及其影响因素,为健康反贫困政策的调整与施行提供借鉴。方法:以2016年全国家庭追踪调查数据为基础,从慢性病患者个人特征、健康水平、卫生服务、医疗保障、疾病预防与控制5个维度出发,选取与其相关的21个评价指标对慢性病患者的健康贫困脆弱性进行综合评价,并通过tobit回归找出影响慢性病患者健康贫困脆弱性的关键因素。结果:慢性病患者个人特征中,城乡、年龄、性别和受教育年限是健康贫困脆弱性的影响因素;慢性病患者健康水平中,健康状态、两周不适、BMI指数和睡眠质量是健康贫困脆弱性的影响因素;慢性病患者医疗服务中,医疗总花费、看病点满意度、对医生的信任度、看病地点和看病点医疗水平是健康贫困脆弱性的影响因素;慢性病患者医疗保障中,医疗保险是健康贫困脆弱性的影响因素;慢性病患者疾病预防与控制中,吸烟和喝酒是健康贫困脆弱性的影响因素。结论:做好脆弱性评估工作,精准识别脆弱性较高的慢性病患者;构建多元参与的共治网络,建立健康贫困脆弱性预警体系;完善慢性病患者医疗服务及医疗保障体系。     

医疗保险参保人住院医疗费用影响因素调查分析

<正>随着医疗体制改革的逐步深入和不断完善,医疗费用过快增长已成为社会普遍关注的问题,分析医疗保险参保人住院医疗费用影响因素,对医院制定有效的医疗保险医疗服务管理措施,抑制医疗费用的增长,在医疗保险改革下医院可持续发展、医疗保险工作顺利进行有积极意义。本文对我院2006～2008年参保患者出院医疗费用构成进行分析,找出影响住院医疗费用的主要因素,为医院建立合理费用控制机制和措施提供依据。     

我国城镇职工基本医疗保险的道德风险及其防范

城镇职工基本医疗保险中道德风险的主要原因是：基本医疗水平较高;覆盖面较窄;医保规定不完善;部分参保单位上缴基金不足等造成医保资金流失。据此,笔者提出建立低水平,广覆盖、多层次的补充医疗保险;进一步完善医保基金筹集和管理;建立有效的个人筹资和医疗费用分担机制等对策。     

温州市高收入职工对特需服务补充医疗保险的需求分析

笔者设计了覆盖基本医疗保险药品目录以外药品费用和特需服务的补充医疗保险方案1和2,通过对温州市高收入职工的意愿参与和意愿支付调查,发现收入、保险价格、对保险的认知、职业情况、罹患慢性病及其对基本医疗保险的了解程度等是影响高收入者对这两种方案意愿参保的主要因素;需求价格弹性分别为-1.07和-1.29。覆盖特需服务的补充医疗保险应注重个性化和多样化需求,并需注意逆向选择。     

商业健康保险对居民健康的影响——来自CGSS数据的经验证据

商业健康保险作为社会医疗保险的有益补充,是推动健康中国战略的重要抓手。本文基于中国综合社会调查(CGSS)数据,采用截面倍差法(DID)与倾向得分匹配法(PSM)估计了商业健康保险对参保居民健康的影响。研究发现:商业健康保险具有正向健康效应,即参加商业健康保险能够显著促进居民健康,提升居民健康水平。通过使用截面倍差法克服因果效应与倾向得分匹配法进行反事实估计发现,商业健康保险对居民健康的正向影响仍然成立。扩展性分析显示,商业健康保险对高收入群体的健康促进效应显著高于低收入群体,同时在40岁以上、中西部地区更显著。本文结论有助于认清商业健康保险对提升居民健康水平的价值与深层影响。     

城乡居民医保制度统筹会产生促健防贫效用?——基于PSM-DID方法的研究

目的:考察城乡居民医保制度统筹带来的健康绩效和防贫绩效。方法:采用2014年和2016年两期中国劳动力动态调查(CLDS)平衡面板数据,分别选用自评健康状况和贫困脆弱性指标衡量个体健康水平和贫困风险抵御能力,使用倾向得分匹配双重差分法分析城乡医保制度统筹的促健防贫效用。结果:基准回归结果和稳健性分析都表明,城乡医保制度统筹能够显著提升个人的健康水平和贫困风险抵御能力;异质性分析发现,城乡医保制度统筹对流动人口并无显著有效的促健防贫效用。结论:城乡医保制度统筹工作的推进应促进区域间和人群间的医疗服务资源合理配置,实现健康平等;施行健康防贫政策;以健康为导向,完善多层次医疗保障体系。     

间接医疗费用对造成家庭重大医疗支出的影响

目的研究间接医疗费用对增加家庭医疗费用负担以及引起家庭重大医疗支出的作用及其影响因素。方法利用2003年全国卫生服务调查资料,定量测算门诊及住院间接医疗费用及其造成的家庭重大医疗支出发生率,并利用回归模型分析其影响因素。结果间接医疗费用在门诊和住院中都非常普遍,间接医疗费用可以直接导致1％-2％的家庭重大医疗支出发生,特别是在农村地区作用更为明显。影响间接医疗费用的主要因素包括收入状况、保险类型,及家庭与卫生机构的距离。结论间接医疗费用不但可以增加家庭的医疗支出,而且可以直接造成家庭重大医疗支出的发生,特别是对于农村地区和弱势人群的作用更加突出。为了更好的解决“看病难”问题,要对间接医疗费用引起足够的重视,并通过提高卫生服务利用的物理可及性和经济可及性、扩大医疗保障覆盖范围和覆盖力度来加以解决,同时还要特别关注弱势群体和农村地区。     

基本医疗保险对家庭消费结构影响的研究*

目的分析基本医疗保障制度对家庭消费结构的影响,为相关政策的制定提供意见和建议。方法数据来源于2014年中国家庭动态跟踪调查(CFPS),样本量为12 305个家庭。采用似不相关回归模型对数据进行分析。结果城乡家庭覆盖基本医疗保险对家庭的食品支出、衣着支出、日常消费支出、居住支出和医疗保健支出具有显著的影响。结论城乡家庭覆盖基本医疗保险影响家庭的消费结构,并且该影响程度在城镇家庭和农村家庭有所不同。     

Demand for medical care in a rural setting: racial comparisons.

Household data from a southern rural community are used to examine racial differences in the utilization of medical care services, and both monetary and nonmonetary determinants of demand are considered. Regression analysis results indicate that office waiting time (for black households) and travel time to the provider (for both black and white households) have a greater impact on demand than price. Racial differences exist in the effects of health insurance coverage and household income on household medical visit expenditures, and both need and household size are found to be consequential determinants of demand.     

Ill health and its potential influence on household consumptions in rural China

Ill health is very expensive and could have significant impact on household consumptions. The purpose of this study is to examine the differences in household consumption patterns among households with or without ill health family member(s) in rural China. We also examine the opportunity cost of ill health by estimating the marginal effects of medical spending on consumption patterns. The data used in this study are from the baseline survey of a community-based rural health insurance study in a poor rural area of China conducted in 2002. The unit of analysis in this study is the household; 4553 households are included in this survey. Fractional Logit model is used as our prediction model. Ill health is measured by the presence of hospitalization and presence of diagnosed chronic disease(s) in a household. Findings from this study reveal that ill health and medical expenditure reduces household investment in human capital, physical capital for farm production, and other consumptions that are critical to human well-being. Subgroup analysis displayed that the impacts of medical expenditure on household consumption patterns described above are more significant in low-income households than in high-income households. In addition, the decline of the percentages of other consumptions is much larger for households with hospitalization than for households with chronic diseases.     

从公平的视角看上海市卫生筹资

描述了上海市卫生筹资公平现状,并与天津、黑龙江和甘肃等省市进行了横向比较。研究发现上海市卫生筹资人均水平较高,且宏观公平性较好;家庭卫生筹资渠道中,基本医疗保险支出和个人现金卫生支出呈累退性;家庭灾难性卫生支出和致贫影响相对其他省市低,但也集中发生在经济水平较低人群。针对这些问题,提出了要建立与收入挂钩的筹资机制、统筹医保资金和加强医疗救助等政策建议。     

Medical expenditure and rural impoverishment in China

Thanks to continued economic growth and increasing income, the overall poverty rate has been on the decline in China. However, due to escalating medical costs and lack of insurance coverage, medical spending often causes financial hardship for many rural families. Using data from the 1998 China National Health Services Survey, the impact of medical expenditure on the poverty headcount for different rural regions was estimated. Based on the reported statistics on income alone, 7.22% of the whole rural sample was below the poverty line. Out-of-pocket medical spending raised this by more than 3 percentage points. In other words, medical spending raised the number of rural households living below the poverty line by 44.3%. Medical expenditure has become an important source of transient poverty in rural China.     

Health insurance enrolment in the Upper West Region of Ghana: Does food security matter?

Toward achieving universal health coverage, Ghana's national health insurance has been acclaimed as a pro‐poor scheme, yet been criticized for leaving the poor behind. Arising from this is how poverty has been operationalized and how poor people are targeted for enrolment into the scheme. We examine the role of food insecurity (not currently considered) as a multidimensional vulnerability concept on enrolment into Ghana's health insurance using binary logistics regression on cross‐sectional survey of household heads (n = 1438) in the Upper West Region of Ghana. Our analyses show that heads of severely food‐insecure households were significantly less likely to enroll in national health insurance scheme (NHIS) relative to households who reported being food‐secure (OR = 0.36, P < .05). We also found education, occupation, and religion as significant predictors of health insurance enrolment. Based on our findings, it is crucial to incorporate food security status in the identification of vulnerable people for free enrolment in Ghana's health insurance.     

对农村医疗保障制度构建的理论思考

适应我国城乡分治、二元经济的现实,确立政府对农民医疗保障经济责任与当地经济水平相适应的观念;适应我国医疗费用上升,医疗风险日益突出的现状,确立农村医疗保障的重点是缓解因病致贫;针对农村基层医疗卫生机构资源优化的趋势,确立农村医疗保障供方多元化的观念;同时应建立家庭帐户和统筹基金相结合的农村医疗保险模式,以适应农村经济以家庭联产承包制为基础的背景。     

Using in-depth qualitative data to enhance our understanding of quantitative results regarding the impact of HIV and AIDS on households in rural Uganda

Two significant challenges face researchers tracking HIV-related socio-economic and demographic change over time in large cohort studies. Firstly, data collected in cohort studies established to describe the dynamics of HIV infection may contain no systematic data on household consumption expenditures which is an established measure of current and long-run household welfare. The second challenge is the choice of the unit of analysis in order to recognise and record impact; this is because most cohorts use the household as that unit. This means that the influence of factors outside that unit cannot easily be tracked. In this paper we show how a detailed understanding of the impact of HIV and AIDS on wider families and social networks, obtained through in-depth longitudinal research with a small number of households, can shed light on the findings from quantitative analysis from a larger cohort in the same population in rural Uganda. The findings of large-scale survey data from more than 2000 households over a 12-year period showed a lack of a strong association between poverty, HIV status and/or death of the household head. In-depth ethnographic research with 26 households in 1991/2 and a restudy of the same households in 2006/7 provide insights into the reasons for this finding: the choice of socio-economic indicators and support from other family and community members play a part in affecting survey findings on the impact of HIV at household level. One other factor is important in explaining the findings. HIV-infected family members from outside the household may drain resources from the household, so looking at the impact of HIV and AIDS on people's wider families provides pointers to why those who have not had an AIDS-related death in their own household may have failed to prosper. Our qualitative findings show that AIDS may well throw households into disarray and poverty, but more often reduces development and hinders families from getting out of poverty. Used strategically, small longitudinal studies can provide important information with which to explain patterns observed in large-scale quantitative datasets.