《保险研究》20230108-《医保药品目录改革、健康改善与医疗服务利用》（高鹏、陈佳、黄秀娟）

［摘   要］本文以2016年国家首次确立医疗保险药品目录动态调整机制为准自然实验，实证检验了医保药品目录改革调整对居民患者健康和医疗费用经济负担的影响。研究发现，医保药品目录动态调整能显著提升患者的健康水平，优化医疗服务利用，但也会显著增加患者个人的医疗费用经济负担，这一结论在通过替换核心解释变量、安慰剂检验、数据缩尾处理、PSM-DID和平行趋势检验等一系列稳健性检验后依然成立；该政策在患者和医疗服务机构两个层面表现出异质性，并通过不同医疗费用补偿方式、医保筹资水平和不同医疗机构类型等渠道对患者产生影响；进一步研究发现，医保药品目录改革政策实施后，患者的门诊医疗费用有所降低，但也显著增加了住院医疗费用、人均医疗费用总支出、住院天数和人均卫生总费用。

［关键词］药品改革；医保目录；实证研究；双重差分法

［作者简介］高鹏（通讯作者），上海财经大学公共经济与管理学院博士生；陈佳，上海财经大学公共经济与管理学院副教授；黄秀娟，甘肃省人民医院血液科主治医师。

The Social Medical  Insurance Drug Catalogue Reform,Health Improvement and Medical Service Utilization

GAO Peng,CHEN Jia,HUANG Xiu-juan

Abstract：Based on the quasi-natural experiment of the establishment of the dynamic adjustment mechanism of the medical insurance drug catalogue in 2016,this paper empirically examines the impacts of the reform and adjustment of medical insurance drug catalogue on the health of residents and the financial burden caused by medical expenses.The study finds that the dynamic adjustment of the medical insurance drug catalog can significantly improve the health level of patients and optimize the use of medical services,but it significantly increases patients′ financial burden related to medical expenses.This conclusion is still valid after a series of robustness tests such as replacing the core explanatory variables,placebo test,data tail reduction processing,PSM-DID and parallel trend test.At the same time,this policy shows heterogeneity at the two levels of patients and medical service institutions,and affects patients through different medical expense compensation methods,medical insurance financing levels and different types of medical institutions.Further research finds that the implementation of the medical insurance drug catalogue reform policy decreases the outpatient medical expenses of patients,but significantly increases the hospital medical expenses,the total medical expenses per capita,the number of days in hospital and the total health expenditure per capita.This conclusion provides insights for further promoting the reform of the medical and health system.

Key words：drug reform;medical insurance catalogue;empirical research;Differences-in Differences method