《保险研究》20191108-《职工医保个人账户对医疗服务消费影响研究——基于2009～2017年省级面板数据的实证分析》（郑先平、朱铭来）

［摘   要］本文利用我国31个省级行政单位2009～2017年相关数据,采用面板固定效应模型,借助工具变量法和广义矩估计法,以个人账户年初人均累计结余为核心解释变量,基于次均医疗服务消费额度和消费频次两个维度,分别检验个人账户对门诊和住院医疗服务消费的影响。研究结果表明:个人账户与门诊次均费用、住院人均医疗费用和住院率显著正相关,与人均门诊人次关系不显著；由于使用范围受到严格限制,为尽快兑现个人账户所有权益,账户持有者会充分利用每次就诊机会消耗账户资金,从而导致门诊和住院次均医疗费用均显著增加；一般单次门诊消耗资金额度小、速度慢,并且时间、经济和精力成本相对较高,因此个人账户对人均门诊就诊次数影响不显著,而住院消耗账户资金隐蔽性强、额度大,所以账户持有者更倾向于通过住院消耗或套取医保资金,导致住院率增加。

［关键词］城镇职工；基本医疗保险；个人账户；医疗服务消费

［基金项目］本文获国家社会科学基金项目“职工基本医疗保险个人账户改革研究”(18BGL199)、江西省社会科学规划项目“城乡居民基本医疗保险制度整合实施绩效评价研究”(16GL33)、江西省高校人文社会科学研究项目“‘健康中国’战略目标下江西省医养结合型养老模式发展研究”(JD17081)资助。

［作者简介］郑先平,南开大学金融学院博士研究生,江西中医药大学副教授,研究方向:保险与社会保障；朱铭来,南开大学金融学院教授,博导,研究方向:卫生经济与医疗保障。

A Study on the Impact of Employees′ Social Medical Insurance Accounts on Medical Service Consumption—Based on an Empirical Analysis of Provincial Panel Data from 2009 to 2017

ZHENG Xian-ping,ZHU Ming-lai

Abstract：Based on the data of 31 provincial administrative units in China from 2009 to 2017,and using the panel fixed effect model and the IV and GMM method,this paper empirically examined the impacts of social medical insurance accounts on the consumption of outpatient and inpatient medical services,based on the two dimensions of average medical service expense each time and consumption frequency and using the accumulated individual account balance at the beginning of the year as the core explanatory variable .The results show that:(1) Individual account is positively correlated with average outpatient cost,average inpatient medical cost and hospitalization rate,but has no significant correlation with average outpatient persion/times;(2) Due to strict restrictions on the scope of use,in order to realize all the rights and interests of individual account as soon as possible,account holders will make full use of each opportunity to consume account funds,thus leading to a high lift of expenses per outpatient and residential service;(3) The amount of account funds consumed by a single outpatient visit is small and slow,and the cost of time,economy and energy is relatively high,so individual account has no significant impact on the number of outpatient visits per capita,while fund consumption at hospitalization is hard to detect and is at a large amount,so account holders are more likely to draw medical insurance funds or arbitrage through hospitalization expenditure,resulting in an increase in hospitalization rate.The conclusion of this study has important enlightenment for the reform of individual social medical insurance accounts in China.

Key words：urban employees;basic medical insurance;individual social medical insurance accounts;consumption of medical services