医疗保险对我国中老年人医疗经济负担的影响

发布时间：2018-05-09 16:35

本文选题：老龄化 + 医疗保险　；参考：《山东大学》2017年硕士论文

【摘要】：随着我国老年人口比重不断攀升,人口老龄化问题日益凸显,中老年人这一特殊群体对医疗服务的需求和要求较高,是医疗保险和医疗保障服务的重点对象。我国从20世纪中后期开始建立基本医疗保险制度,近年来对医疗保险制度的改革和创新更是力度空前。但是,由于社会、经济和历史等多方面的原因,我国的医疗保险制度仍存在很多问题,在人口老龄化背景下,研究我国医疗保险制度对中老年人医疗经济负担的影响具有深远的现实意义。本文在对以往文献进行梳理评述之后,首先介绍了目前我国的老龄化问题和中老年人健康的现状,并对医疗保险发展的情况进行分析,同时结合相关经济学理论和医疗保险理论阐述本文研究的理论基础。其次,基于医疗负担的测算方法,选取宏观成本法和人力资本法分别测算直接医疗费用和间接医疗费用,并确定医疗经济负担的其他相关指标,分地区、年龄和医疗保险类型对医疗负担进行初步评价。然后选取CHARLS2013年的全国基线调查数据,采用适当的实证模型控制内生性和样本选择偏误问题,衡量不同医疗保险制度对各类医疗经济负担指标的影响,并区别门诊与住院形式的不同,比较年龄分组和城乡差异。最后,为了进一步研究大额医疗费用带来的因病致贫、返贫问题,结合城乡居民大病保险的实施,利用2013年的数据进行预测,衡量基本医疗保险和城乡居民大病保险对灾难性卫生支出的作用。通过实证分析可以看出:医疗保险对住院费用的作用比门诊费用更显著,其中城镇职工医疗保险显著促进了门诊和住院费用的增加且增加幅度最大;城市居民得益于优越的医疗资源和经济条件,其医疗费用支出远大于农村,不同年龄段的医疗费用支出也有显著不同;各类基本医疗保险显著降低了医疗费用的自负比例,但是对于降低医疗自负负担的作用较弱;城乡居民大病保险在基本医疗保险补偿基础上进行的二次报销可以进一步降低灾难性卫生支出的发生率,减少平均差距和相对差距,但是不同收入群体的作用效果有所差异,对低收入群体的效果有待加强,未来随着大病保险的进一步发展,其对灾难性卫生支出的作用会进一步提高。本文在完善医疗负担测评指标的基础上,更加全面的分析了医疗保险制度对医疗经济负担的作用,并对不同医疗保险制度类型进行对比,区别就医形式、年龄段与城乡。同时,对大病保险的实施情况进行预测,进一步分析了医疗保险对灾难性卫生支出的作用效果,为今后政策实施的偏重点与改革重点提供了借鉴。
[Abstract]:With the increasing proportion of the elderly population in our country, the problem of aging population is becoming increasingly prominent. The special group of middle-aged and elderly people have a high demand for medical services, which is the key object of medical insurance and medical security services. The basic medical insurance system has been established in China since the middle and late 20th century. In recent years, the reform and innovation of the medical insurance system is unprecedented. However, due to social, economic and historical reasons, there are still many problems in China's medical insurance system. It is of great practical significance to study the effect of medical insurance system on the financial burden of medical care. After combing and commenting on the previous literatures, this paper first introduces the aging problem and the current situation of the health of the middle-aged and the elderly in China, and analyzes the development of medical insurance. At the same time, combined with the relevant economic theory and medical insurance theory to elaborate the theoretical basis of this study. Secondly, based on the calculation method of medical burden, we select macro cost method and human capital method to calculate direct medical cost and indirect medical cost respectively, and determine other related indicators of medical economic burden. Age and type of medical insurance were used to evaluate the medical burden. Then select the national baseline survey data of CHARLS2013 year, adopt appropriate empirical model to control endogenous and sample selection bias, and measure the impact of different medical insurance systems on various indicators of medical financial burden. And the difference between outpatient and hospitalization, age groups and urban and rural differences. Finally, in order to further study the problem of poverty caused by illness and return to poverty caused by large medical expenses, combined with the implementation of urban and rural residents' serious illness insurance, the 2013 data are used to forecast, Measure the effect of basic medical insurance and urban and rural residents' serious illness insurance on catastrophic health expenditure. Through the empirical analysis, we can see that the effect of medical insurance on the inpatient expenses is more significant than that on the outpatient expenses, among which, the urban workers' medical insurance significantly promotes the increase of outpatient and inpatient expenses and the biggest increase; Urban residents benefit from superior medical resources and economic conditions, their medical expenses are far larger than those in rural areas, and the expenditure on medical expenses varies significantly among different age groups; all kinds of basic medical insurance have significantly reduced the proportion of medical expenses borne by themselves. But it has a weak effect on reducing the burden of medical conceit. The secondary reimbursement based on the basic medical insurance can further reduce the incidence of catastrophic health expenditure and reduce the average gap and the relative gap between urban and rural residents. However, the effects of different income groups are different, and the effects on low-income groups need to be strengthened. In the future, with the further development of serious illness insurance, its effect on catastrophic health expenditure will be further improved. On the basis of perfecting the evaluation index of medical burden, this paper analyzes the effect of medical insurance system on medical economic burden, and compares the different types of medical insurance system to distinguish the form of medical treatment, age group and urban and rural areas. At the same time, the implementation of the serious illness insurance is forecasted, and the effect of the medical insurance on the catastrophic health expenditure is further analyzed, which provides a reference for the emphasis of the policy implementation and the reform emphasis in the future.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D669.6;F842.684

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