我国大病医疗保险报销规则研究

大病医疗保险中的道德风险对医疗保险基金的可持续运行带来挑战。本文对能够减少道德风险的大病医保报销模式展开了研究。理论分析表明,在最大化社会总福利的目标下,应对选择低费用治疗方案的消费者提供补贴,对选择高费用治疗方案的消费者设定自付比例。模拟表明这种差异化报销规则相对于单一报销规则,降低了医疗费用和医疗保险费。本文还对模拟所用的参数选择进行了敏感性检验,结果表明,不同的参数选择不会改变本文所揭示的机理。

Study on the reimbursement rules of catastrophic disease health insurance in China

Moral hazard in the catastrophic disease health insurance has challenged the sustainability of medical budget funds. This paper studies the health care reimbursement rule to counteract moral hazard. Theoretical analysis shows that in the target to maximize social welfare, the optimal rule is to provide consumers who choose low-cost treatment with subsidies and charge a co-payment to those who choose high-cost one. Adopting simulation approach shows that this difference with respect to single reimbursement rules, healthcare expenses and medical insurance premiums will be significantly reduced compared to a unified co-payment ratio. This paper also selects the sensitivity test simulation parameters and the results show that different values will not change the herein disclosed mechanism results.