我国基本医疗保险住院服务受益公平性研究

目的:研究我国三种基本医疗保险制度下住院服务受益公平性问题。方法:利用中国家庭动态跟踪调查(CFPS)2010年基线调查数据,运用两部分模型来探讨不同制度下、不同收入水平的参保人群在医保覆盖的住院服务利用率和住院经济补偿两方面是否存在差异。结果:各收入组别在住院服务利用率方面差异不大;而在报销住院费用方面,较高收入组和最高收入组的医保报销费用分别比最低收入组高26.3%和36.5%。具体到每一制度,城镇职工医保不同收入组之间的报销费用不存在显著差异;城镇居民医保参保人员报销费用随收入水平的增加而呈现上升趋势;新农合制度只有最高收入组与最低收入组之间存在一定差异。结论:我国基本医疗保险在住院服务利用率方面不存在明显的不公平特征,但在医保报销水平上存在与收入相关的不公平特征。城镇职工医保的公平程度较高,新农合次之,而城镇居民医保受益公平性最差。从制度间的比较而言,新农合参合人员的住院率和医保报销费用均显著偏低。应积极推进基本医疗保险制度整合,加强医疗救助体系建设,完善大病保险制度,以改善制度公平性。

Study on hospitalization benefit equity of the basic medical insurance programs in China

Objective:To analyze the equity of benefit for inpatient services under the three basic medical insurance programs in China. Methods:Using the baseline survey data collected by China Family Panel Studies (CFPS) in 2010, and the two-part model was applied to explore whether the insured groups with different income levels had different aspects on inpatient rate and the compensation of hospitalization expenses in health insurance coverage. Results:There was no significant difference in the inpatient service utilization rate for different income groups, but the highest and second highest income groups reimburse more expenses than the lowest income group, that is 36.5% and 26.3%, respectively. Specifically, the income level and the compensation amount are not significantly correlated in the Urban Employer Medical Insurance (UEMI) program; the compensation amounts to be paid by urban residents are basically increasing with the increase of the income level; and there is a moderate discrepancy between the highest and the lowest income groups in the New Rural Cooperative Medical System (NCMS). Conclusion:The benefit equity is obviously fair in terms of inpatient service utilization rate, but the benefit degree increases for higher income groups, which shows that there are unfair inequalities related to the income at the level of reimbursement. In terms of program comparison, the benefit degree equity is higher for the UEMI program, followed by the URMI program and the NCMS program is the worst. Besides, the impatient rate and reimbursement amounts are significantly lower for NCMS program participants. The government should merge URMI and NCMS programs, actively promote the integration of basic medical insurance system by strengthening the construction of the medical assistance system and improving the system of catastrophic disease medical expenditure insurance in order to achieve better benefit equity.