我国城镇居民基本医疗保险医疗服务利用公平性研究

作为一种收入再分配机制,城镇居民基本医疗保险应该在制度设计中体现对弱势群体的倾斜,如慢性病和低收入人群。因此,弱势群体获得的医疗服务状况是否得到改善,是决定城镇居民基本医疗保险制度成效的重要指标。本研究通过双重差分模型(DID)分析城镇居民基本医疗保险建立前后不同社会经济及健康状况的强、弱势人群在医疗服务方面的利用情况(包括门诊和住院两个方面),根据不同人群间医疗服务利用情况差距的改变来衡量城镇居民基本医疗保险的的公平性。研究发现,通过城镇居民基本医疗保险的建立和施行,缩小了不同社会经济地位和健康状况的强、弱势群体之间保障水平的差距,弱势人群的医疗服务利用水平明显提高,健康状况明显改善,从纵向和横向两个方面都证明了城镇居民基本医疗保险的建立提高了不同人群间医疗保障的公平性。

Equity on healthcare service utilization of China's Urban Resident Basic Medical Insurance

As an income redistribution mechanism, the design of Urban Resident Basic Medical Insurance (URBMI) should reflect the inclination to take care of vulnerable populations, such as people with chronic diseases and low incomes. Therefore, whether the healthcare services of vulnerable populations have been improved, is the most important indicator to determine the effectiveness of the URBMI. Using the DID model, this paper analyzes healthcare service utilization of invulnerable and vulnerable populations before and after the establishment of URBMI (including both outpatient and inpatient), based on the idea that these two populations have different socio-economic and health status. Then, based on the gap between the healthcare service utilization changes of different groups, we can measure the equity in URBMI. The results show that the establishment and implementation of URBMI has indeed narrowed the gap of invulnerable and vulnerable populations with different socio-economic and health status; healthcare service utilization of vulnerable populations has increased significantly, and health status has significantly improved. From vertical and horizontal perspectives, the results prove that the establishment of URBMI has improved the equity of healthcare service utilization among different populations across China.