城乡统筹医疗保险真实保障水平研究——基于天津市的实证分析

目的:对城乡统筹居民医疗保险真实保障水平进行实证研究,为切实提高我国参保患者医疗保障水平提供证据。方法:利用频数分布和虚拟变量回归模型方法对天津市城乡参保居民就医微观数据进行统计分析。结果:城乡居民基本医疗保险真实保障水平与政策范围内保障水平之间差距较大;医疗保险起付线、政策范围内报销比、参保患者年龄、缴费级别、医疗费用、医院级别等因素均会对患者真实保障水平产生显著影响。结论与建议:在医疗保险制度完善阶段,为提高参保患者真实保障水平,应淡化医疗保险政策范围内报销比、设定医疗保险政策范围内保障水平和真实保障水平差距的评价范围、细化医疗保险政策内容,科学设置阶梯型医疗保险政策范围内报销比、增加政府卫生财政投入,同时进一步完善多层次城乡居民医疗保险制度体系。

The real rate of reimbursement on urban-rural integration medical insurance:Empirical anal-ysis of Tianjin city

Objective: To effectively improve the health insurance security level of urban-rural residents and offer corresponding policy recommendations, the paper makes an empirical analysis of the security level of China's urban and rural residents health insurance system(U&RRHIS). Methods: Frequency distribution and dummy variable regression tests were conducted with Tianjin's urban-rural residents health insurance database. Results There is a large gap between real rate of reimbursement and policy rate in U&RRHIS; many factors have significant impacts on the real rate of reimbursement, including deductible tables, nominal rates of reimbursement, the age of the insured, insurance payment levels, medical expenses, medical institution classifications, etc. Conclusion: In order to improve the real rate of reimbursement for the insured, more attention should be paid to the real rate of reimbursement which is an important index of health security levels for health insurance policy adjustments; meanwhile, efforts should be made in terms of implementation, for instance, criteria should be established for an evaluation of the gap between the real rate of reimbursement and the policy rate of reimbursement, while medical insurance policies should be refined and a scientific and laddered policy rate of reimbursement should be established; moreover, the government's financial input in healthcare should be increased and the medical insurance system should be improved.