《保险研究》20231207-《医疗保险异地就医直接结算政策对跨省流动人口参保行为的影响：基于居留意愿的调节效应》（何文、张蓉）

［摘   要］流动人口参保率低是制约我国社会医疗保险实现全民覆盖的重要问题。本文基于“中国流动人口动态监测调查”2016～2018年三期微观数据和定点医院宏观数据，运用双重差分模型实证检验医保异地就医直接结算政策对跨省流动人口参保行为的影响，并分析流动人口居留意愿对政策效果的调节效应。研究结果表明：政策实施后，跨省异地就医的医保报销水平和可及性明显改善，流动人口的参保概率也随之显著提高了12.4%；由于政策实施初期仅覆盖了住院费用，因此只有当流入地的三级医院能够实现联网结算时，该政策才会对个体的参保行为产生显著影响，直接结算业务范围的限制也使得流动人口的参保意愿没有随着定点医院数量的增加以及政策实施时间的延长而进一步提高；随着户籍制度改革的持续深化，有长期居留意愿的流动人口会更加期望在流入地参保，因此个体的居留意愿对政策的参保促进效果具有负向的调节效应。

［关键词］异地就医；直接结算；流动人口；参保行为；居留意愿

［基金项目］湖南省自然科学基金青年基金项目“医保异地即时结算对流动人口参保意愿及健康状况的影响研究”（2021JJ40127）；国家自然科学基金青年基金项目“医疗保险对慢性病门诊治疗的引导作用、保障效果及政策优化研究”（72204079）。

［作者简介］何文，湖南大学公共管理学院助理教授、硕士生导师，研究方向：医疗保障；张蓉，湖南大学公共管理学院本科生，研究方向：医疗保障。

The Impact of Immediate Reimbursement for Trans-provincial Medical Treatments on the Willingness of Floating Populations to  Enroll in the Social Medical Insurance Scheme:The Moderating Role of Settlement Intention

HE Wen,ZHANG Rong

Abstract：The low participation rate of floating population is an important problem that restricts the realization of universal social medical insurance coverage in China.Based on the individual-level data from the China Migrants Dynamic Survey (CMDS) collected from 2016 to 2018 as well as designated hospital data at the city level,this paper empirically tests the impact of immediate reimbursement for trans-provincial medical treatments on the willingness of floating populations to enroll in the medical insurance system by using the difference-in-differences model,and further analyzes the moderating role of settlement intention on the policy effect.The results show that:after the policy change,the level and accessibility of reimbursement for trans-provincial medical treatments have been significantly improved,which has increased the willingness of the floating population to enroll in the social medical insurance scheme by 12.4%.At the beginning of the implementation of the policy,only inpatient expenses were covered.Therefore,only when the recipient province′s tertiary hospitals can realize the immediate reimbursement will it have a significant impact on the individual's behavior,and the floating population′s willingness has not increased significantly with the increase of the number of designated hospitals and the extension of the implementation time of the policy change because of the reimbursement scope restriction.Finally,with the continuous deepening of the reform of the household registration system,the floating populations with long-term settlement intention will be more willing to enroll in the social medical insurance scheme of the recipient province,so the settlement intention plays a negative regulatory role in the positive effect of the policy change.

Key words：trans-provincial medical treatments;immediate reimbursement;floating population;participation behavior;settlement intention