《保险研究》20260307-《异地就医与医疗费用增长——来自城乡居民医保结算数据的经验证据》（张财经、张奇林、刘二鹏）

［摘   要］本文基于东部某县的城乡居民医保结算数据，实证检验了异地就医对患者医疗费用和医保基金支出的影响，分析了不同监管维度下的异质性。结果显示，异地就医会显著增加患者门诊和住院的次均医疗费用支出。进一步区分异地就医类型发现，省内异地就医在门诊与住院费用上均出现显著增长，而跨省异地就医的费用上涨则主要集中在住院上。无论省内还是跨省，异地就医导致的费用增长均表现为患者自付费用的大幅攀升以及参保地医保基金的明显流失。基于不同监管维度的异质性分析表明，异地就医的费用增长效应在自由裁量权更高的病种、等级更低的医疗机构中更加明显。上述发现为推进并完善异地就医结算政策提供了经验证据，为降低居民异地就医费用和提升医保制度可持续性提供了参考。

［关键词］异地就医；医疗费用；异地监管；城乡居民医保

［基金项目］教育部人文社会科学重点研究基地重大项目“共同富裕目标下第三次分配的理论建构与实现路径研究”（22JJD630016）、国家自然科学基金面上资助项目“从单主体到多主体：基于供地视阈的城市公租房供给改革及其农民工福利效应研究”（72174090）、国家自然科学基金青年项目“制度环境、村干部行动与新型农村集体经济发展：机理、效果与对策”（72303100）和江苏省社科基金一般项目“村干部行动提升江苏新型农村集体经济发展绩效的机制与对策研究”（23GLB013）。

［作者简介］张财经，武汉大学社会保障研究中心博士研究生；张奇林（通讯作者），武汉大学社会保障研究中心教授；刘二鹏，中南财经政法大学财政税务学院副教授。

Cross-Regional Medical Treatment and Medical Expenditure Growth—Evidences from Urban-Rural Residents′  Basic Medical Insurance Settlement Data

ZHANG Cai-jing，ZHANG Qi-lin，LIU Er-peng

Abstract：Using urban-rural resident basic medical insurance settlement data from an eastern county in China，this study empirically examines the impact of cross-regional medical treatment on patients′ medical expenditures and medical insurance fund payments，and explores heterogeneity across regulatory dimensions.The results show that，cross-regional treatment significantly increases per-visit outpatient and inpatient expenditures.Further analysis indicates that intra-provincial off-site treatment raises both outpatient and inpatient costs，whereas inter-provincial treatment mainly increases inpatient expenditures.In both cases，rising expenditures are driven by substantial increases in patients′ out-of-pocket payments and notable outflows of insurance funds from the place of enrollment.Moreover，the expenditure-increasing effects are more pronounced for diseases with greater provider discretion and in lower-level medical institutions.These findings provide empirical evidences for improving cross-regional medical settlement policies and offer policy implications for curbing medical cost growth and enhancing the sustainability of the medical insurance system.

Key words：cross-regional medical treatment;medical expenditures;cross-regional regulation;urban-rural residents′  basic medical insurance