《保险研究》20210105-《门诊保障制度改革“以门诊换住院”的政策效应分析——基于中国职工医保抽样数据的实证检验》（朱凤梅、张小娟、郝春鹏）

［摘   要］本文利用中国医疗保险研究会2017年职工医保抽样数据库(CHIRA)和66个样本城市职工医保门诊报销政策文件,将实施“门诊统筹”作为外生冲击和改革变量,研究门诊保障制度改革对参保患者门诊和住院服务利用、医疗费用支出的影响。基于双变量Probit模型以及OLS模型的回归结果显示,门诊保障制度改革会带来两种效应:门诊服务和住院服务的“替代效应”,即门诊保障制度改革显著提高了参保患者对门诊服务的使用(年门诊就诊概率上升37.3%),同时减少了对住院服务的使用(年住院概率下降4.6%)；门诊费用和住院费用的“支出效应”,即门诊保障制度改革显著提高了参保患者的年门诊费用支出,同时减少了年住院费用支出,但不会降低参保患者的年医疗费用总支出。进一步研究发现,改革带来的政策效应因门诊保障程度、参保群体(在职职工和退休职工)和改革时长存在异质性。

［关键词］门诊保障制度；门诊统筹改革；替代效应；支出效应；双变量Probit模型

［作者简介］朱凤梅,中国社会科学院经济研究所助理研究员；张小娟,中国医学科学院医学信息研究所副研究员；郝春鹏,中国医疗保险研究会副秘书长。

The Reform of Outpatient Security System:Policy Effect Analysis of "Replacing Outpatient Service with Hospitalization"—The empirical test based on the sample data of CHIRA

ZHU Feng-mei,ZHANG Xiao-juan,HAO Chun-peng

Abstract：Based on sample data of medical insurance for urban employees from China Medical Insurance Research Association in 2017 and urban employee outpatient pooling policies of 66 cities,the Paper analyzed the impacts of the reform of outpatient security policies on service utility (outpatient and inpatient services) and medical cost with “comprehensive compensation for outpatient cost” as exogenous shocks and reform variables.Based on the results of Bioprobit model and OLS regress model,the reform of outpatient security policy can bring two kinds of impacts:(1)the substitution effect between outpatient and inpatient service,which means the reform of outpatient security policy can increase the utility of outpatient services (the annual probability of using outpatient service increased by 37.3%) and decrease the utility of inpatient service (the annual probability of using inpatient service decreased by 4.6%) ;(2)the “expenditure effect” of outpatient and inpatient costs,which means the reform can increase the outpatient cost significantly and decrease inpatient costs,however the total medical cost does not decrease.What’s more,the impacts of the outpatient security policy reform are heterogenous due to differences in level of protection,insured group (in-service employee and retired employee) and the duration of reform.

Key words：outpatient security system;outpatient pooling reform;substitution effect;expenditure effect;Bioprobit model