《保险研究》20210308-《医保起付线对医疗服务利用和医疗费用的影响》（封进、吕思诺、王贞）

［摘   要］本文针对医保起付线政策的作用机制,采用起付线变化的外生政策实验,利用断点回归方法,评估了降低门诊起付线对医疗服务利用和医疗费用的影响。研究发现,降低起付线使患者面对的平均医疗价格下降,医保报销费用显著增加,对于本文涉及的特定政策和样本而言,起付线下降1%,患者平均的医保基金支出增加约为2%,说明医保基金支出对于起付线变化的弹性可能比较大。但起付线政策对于健康需求程度不同的参保人有不同的影响,降低起付线对医疗费用处于较低和较高水平患者的年度医疗支出影响不明显,对于医疗费用处于中间水平且数量占比较大的患者群体有显著影响。此外,研究结果还表明,起付线一方面具有很强的控费作用,另一方面也能促进健康需求较低的参保人选择基层医疗服务。本文的研究发现对于设计和完善门诊统筹报销政策具有一定的政策含义。

［关键词］医保起付线;医保基金支出;医疗道德风险

［基金项目］国家自然科学基金项目(71974036;72003039)、教育部哲学社会科学研究重大课题攻关项目(17JZD028)、中国博士后科学基金面上项目(2019M661382)、上海市“超级博士后”激励计划(2019242)的资助。

［作者简介］封进,复旦大学经济学院教授,经济学博士,研究方向:健康经济学、社会保障、劳动经济学；吕思诺,复旦大学经济学院博士研究生,研究方向:健康经济学、社会保障；王贞(通讯作者),复旦大学经济学院博士后,经济学博士,研究方向:健康经济学、社会保障。

The Effects of Deductibles on Healthcare Utilization and Medical Expenses

FENG Jin,LV Si-nuo,WANG Zhen

Abstract：The paper studied the effects of deductibles in health insurance,and evaluated the impacts of reducing deductibles on healthcare utilization and medical expenses,using the exogenous policy experiment and the regression discontinuity method.It reveals that the average medical care price decreases with the reduction of deductible amount,and therefore,the medical insurance expenses reimbursed increase significantly.For the specific policy and samples employed in the paper,a 1% reduction of the deductible amount leads to about 2% increase in medical insurance fund expenditures,indicating that the elasticity of the medical insurance fund expenditure to the changes of deductibles is rather high.Furthermore,the effects of deductibles vary with participants with different health care demands.For patients with relatively low or high medical expenditure,lowering the deductible amount has no significant effect on their annual medical care expenditure.However,there is a significant impact on patients whose medical expenditure is at the intermediate level,and these people account for a large proportion.Besides,the results show that,while the deductibles play an important role in controlling medical care expenditures,it can also motivate those with relatively low health demand to choose primary medical care services.The paper sheds light on implications for designing and improving out-patient reimbursement policy.

Key words：social medical insurance deductibles;medical insurance fund expenditure;medical moral hazard