《保险研究》20220606-《职工医保省级统筹对医疗费用支出的影响——基于CFPS数据的研究》（李锐、吴菁、杨华磊）

［摘   要］在鼓励推进基本医疗保险省级统筹的政策背景下,本文研究省级统筹是否会增加医保基金支付风险问题。本文基于交叠双重差分方法,结合宏微观调查数据及各地区职工医保省级统筹实施办法,探究职工医保省级统筹对参保人各项医疗费用支出的影响及其传导机制。研究发现:实施职工医保省级统筹会提高参保人医疗费用支出,尤其是门诊费用和报销费用在统筹后显著上涨；职工医保省级“统收统支”会让下级政府放松监管力度,纵容参保人增加对优质医疗服务资源的需求,但住院等级差别报销机制会抑制住院费用的上升；风险调剂金制度中的“责任分担”机制可控制医疗费用过快上涨,但效果微弱；参保人年龄越大医疗费用支出增长越快,且在省级统筹后增长幅度更大。因此,在推进医保统筹层次提高的过程中,应注意防范不同年龄阶段参保人的过度医疗行为,并尽快落实医保基金“统收统支”和相关医保基金监管机制,合理控制医保基金支出,促进医保基金可持续发展。

［关键词］医保基金；医疗费用；统收统支；责任分担

［基金项目］国家社科基金后期资助项目“中国养老保险制度中的退休激励问题研究”(2021937)。

［作者简介］李锐,中南财经政法大学公共管理学院教授,研究方向:劳动经济与养老保障；吴菁(通讯作者),中南财经政法大学公共管理学院博士研究生,研究方向:医疗保障与健康行为；杨华磊,中南财经政法大学公共管理学院副教授。 感谢中南财经政法大学吕国营教授及审稿专家为本文的提供的宝贵建议,文责自负。

The Impact of Provincial Pooling of the Basic Medical Insurance for Employees on Medical Expenditures—An Investigation Based on CFPS data

LI Rui,WU Jing,YANG Hua-lei

Abstract：Against the background of encouraging provincial pooling of the basic medical insurance for employees,the paper studied the issue whether provincial pooling increased the payout risk of the basic medical insurance fund.Based on the Difference-in-Difference model,and in combination with micro and macro investigation statistics and pooling methods of different provinces,this paper investigated the impact of provincial pooling of employees′ basic medical insurance on participants′ medical expenses and its transmission mechanism.The study finds that:firstly,provincial pooling of employees′ basic medical insurance increases participants′ medical expenses,especially outpatient expenses and reimbursement expenses increase significantly after the pooling;secondly,the provincial pooling induces lower-level governments to relax their supervision,tolerating participants to increase their demand for better quality medical services,but differentiated reimbursement policy for hospitalization expenses can restrain the rise of this expense;thirdly,the "responsibility-sharing" mechanism in the risk adjustment fund system has a very weak effect in controlling the rapid increase in medical expenses;lastly,the older the participant is,the faster the increase in medical expenses,and the trend is more pronounced after provincial pooling.Therefore,in the process of upgrading the pooling level of the basic medical insurance fund,we should pay attention to the excessive medical behaviors of different age groups.In addition,we should accelerate the implementation of the "unified collection and expenditure" of basic medical insurance funds and relevant regulatory mechanisms on the funds,reasonably control the medical insurance fund payout,and promote its sustainable development.

Key words：basic medical insurance fund;medical expenses;unified collection and expenditure;responsibility sharing