《保险研究》20260207-《基本医疗保险对患者临终医疗的影响研究》（徐卓晨、张跃华）

［摘   要］中国人口结构正朝着高龄化、慢病化与失能化的方向发展，整体死亡率持续攀升，终末期医疗服务需求随之不断扩大。在此背景下，探讨医疗保险待遇对患者临终阶段医疗服务利用及医疗费用的影响具有重要的现实意义。本文基于中国健康与养老追踪调查（CHARLS）数据研究发现，参加基本医疗保险会显著提高患者临终住院总费用及个人自付支出，这一效应在倾向于积极治疗的低龄临终患者中尤为明显。此外，基本医疗保险激励了临终患者的住院行为，但住院费用的增长主要集中在中等经济水平家庭。进一步分析表明，不同医保类型在实际报销水平、账户结构等方面的制度差异，是导致不同群体临终医疗费用存在差距的重要制度因素。这说明基本医疗保险对临终阶段的医疗需求具有明显的拉动作用。因此，应进一步完善基本医疗保障体系，逐步缩小制度间与人群间的待遇差距，并积极推动安宁疗护发展，以优化临终医疗资源的配置效率。

［关键词］基本医疗保险；临终医疗利用；医保制度结构；医疗费用；CHARLS

［基金项目］本研究受中国保险学会专项课题、国家社会科学基金重大项目（21&ZD077和23&ZD045）、国家自然科学基金项目（71973094和72173085），以及中央高校基本科研业务费专项资金资助。

［作者简介］徐卓晨，浙江大学博士研究生；张跃华，浙江大学公共管理学院&民生保障与公共治理研究中心、浙江大学长三角智慧绿洲创新中心教授，研究方向：社会保障。

A Research on the Impact of Basic Medical Insurance on Patients’ End-of-Life Medical Care

XU Zhuo-chen，ZHANG Yue-hua

Abstract：China’s demographic structure is characterized by population aging，prevalence of chronic diseases and greater disability incidence，with the overall mortality rate rising constantly.As a result，terminal-stage medical demands keep expanding.Therefore，it is of practical significance to study the impacts of the basic medical insurance benefits on patients’ access to end-of-life medical services and medical expenditure.Based on the CHARLS data，the research finds that participation to the basic medical insurance significantly increases patients’ total hospitalization expenses for both end-of-life treatments and out-of-pocket expenses.This effect is more pronounced among terminally ill patients of lower age who tend to seek proactive treatments.In addition，the basic social medical insurance also incentivizes hospitalization behaviors of end-of-life patients，but the increase in hospitalization expenses mainly arises from middle-income families.Further analysis indicates that the differences in reimbursement level and account structure of different type of social medical schemes are the crucial factor affecting the end-of-life medical expenses of patients.The above findings demonstrate that social medical insurance schemes incentivize demands for terminal-stage medical services，therefore we should improve on the social medical security system step by step，narrow down the benefit differences among schemes and population groups gradually，and promote the development of hospice care，so as to optimize the efficiency of medical resource allocation.

Key words：basic medical insurance；end-of-life medical care access；the structure of the basic medical insurance system； medical expenses；CHARLS