《保险研究》20190210-《长期护理保险对医疗费用的影响——基于青岛模式的合成控制研究》（于新亮、刘慧敏、杨文生）

［摘   要］本文选取2000～2016年中国包括青岛市在内的35个城市面板数据,采用合成控制法首次量化评估了长期护理保险对医疗费用支出的政策影响。研究发现,青岛市在实施长期医疗护理保险制度之后,人均医疗费用短暂下降,随后迅速持续增高,总体上升幅度约为6.18%,且评估结果通过了一系列稳健性检验。进一步发现,青岛市医院的医疗费用支出增长变动不大,而基层医疗机构的医疗费用支出显著增长。长期护理保险实施对医疗费用增长的结构性影响为长期护理保险引起医疗费用不降反升提供了解释。在护理需求甚至医疗需求均受到长期抑制的现实背景下,开展长期护理保险将发挥释放需求效应,并能有效调节医疗资源的分配和利用,有利于实现整个医疗服务产业的优化配置。长期护理保险仍需加强与基本医疗保险的分工与配合,从而提升社会整体福利。

［关键词］长期护理保险；医疗费用；释放效应；合成控制法

［基金项目］国家自然科学基金青年科学基金项目“灾难性卫生支出风险识别、致贫路径与精准保障研究”(批准号:71804090)；山东省自然科学基金“马尔科夫调制风险模型下的随机优化控制问题研究”(批准号:ZR2018MG002)；山东省社会科学规划专项项目——青年学者重点培养计划一般项目“精准扶贫视角下的山东省城乡居民多层次医疗保障补偿机制优化研究”(批准号:17CQXJ01)；山东省社会科学规划一般项目“山东省长期护理保险运行绩效与制度优化研究”(批准号:18CJJJ18)。

［作者简介］于新亮,山东财经大学保险学院副教授,研究方向:保险经济学、卫生经济与医疗保障；刘慧敏,山东财经大学保险学院本科生,研究方向:保险经济学、卫生经济与医疗保障；杨文生,山东财经大学保险学院教授,研究方向:保险理论与实务、长期护理保险；范红丽(通讯作者),山东财经大学保险学院副教授,研究方向:健康经济学和居家护理。

Long-term Care Insurance’s Impacts on Medical Expenditure—Based on Synthetic Control Research on Qingdao Case

YU Xin-liang,LIU Hui-min,YANG Wen-sheng,FAN Hong-li

Abstract：This paper selected panel data of 35 cities including Qingdao from 2000 to 2016,and used the synthetic control method to evaluate the policy impact of long-term care insurance on medical expenditure.The study found that after the implementation of long-term care insurance in Qingdao,the medical expenditure per capita decreased briefly,then increased continuously,with an overall increase of about 6.18%,and the evaluation results passed a series of robustness tests.This paper further found that the medical expenditure growth of hospitals in Qingdao city proper was not much,while the medical expenditure of primary medical institutions was significantly increased.The structural impact of long-term care insurance on the growth of medical expenditure provides an explanation for the rise instead of decrease of medical expenditure caused by long-term care insurance.Under the realistic background that the nursing demands and even the medical demands are restrained for a long time,long-term care insurance will release the demands in a long run,and can effectively adjust the distribution and utilization of medical resources,which is conducive to realizing the optimal allocation of the entire medical service industry.Long-term care insurance still needs to strengthen the job division and cooperation with basic medical insurance,so as to enhance the overall welfare of society.

Key words：long-term care insurance;medical expenditure;release effect;synthetic control