中国卫生政策研究
中國衛生政策研究
중국위생정책연구
CHINESE JOURNAL OF HEALTH POLICY
2014年
5期
42-48
,共7页
转移接续%逆向选择%健康移民现象%医疗保险
轉移接續%逆嚮選擇%健康移民現象%醫療保險
전이접속%역향선택%건강이민현상%의료보험
Portability%Adverse selection%Healthy migrant%Medical insurance
目的：检验医保关系转移接续过程是否存在成本转嫁和逆向选择行为的理论假设，并评估其对医保基金的影响。方法：运用A市医保系统2011-2012年转移接续数据，对转入组和转出组各变量的差异分别进行卡方检验和t检验，运用多元回归分析探索门诊和住院报销费用的影响因素。结果：卡方检验表明，转入组与转出组在年龄和患有门诊慢性病和门诊特殊疾病方面存在显著差异，这说明转移接续过程存在逆向选择行为；t检验表明，转入组与转出组在人均住院费用及人均住院报销费用方面有显著差异；多元回归分析显示，年龄和患门诊慢性病和门诊特殊疾病对门诊及住院报销费用有显著影响。政策分析表明，医保基金存在转嫁成本的规定。结论：由于健康移民效应和风险选择的作用，转入组的门诊和住院费用对医保基金的影响并不大，地方医保基金可以进一步执行转移接续政策。
目的：檢驗醫保關繫轉移接續過程是否存在成本轉嫁和逆嚮選擇行為的理論假設，併評估其對醫保基金的影響。方法：運用A市醫保繫統2011-2012年轉移接續數據，對轉入組和轉齣組各變量的差異分彆進行卡方檢驗和t檢驗，運用多元迴歸分析探索門診和住院報銷費用的影響因素。結果：卡方檢驗錶明，轉入組與轉齣組在年齡和患有門診慢性病和門診特殊疾病方麵存在顯著差異，這說明轉移接續過程存在逆嚮選擇行為；t檢驗錶明，轉入組與轉齣組在人均住院費用及人均住院報銷費用方麵有顯著差異；多元迴歸分析顯示，年齡和患門診慢性病和門診特殊疾病對門診及住院報銷費用有顯著影響。政策分析錶明，醫保基金存在轉嫁成本的規定。結論：由于健康移民效應和風險選擇的作用，轉入組的門診和住院費用對醫保基金的影響併不大，地方醫保基金可以進一步執行轉移接續政策。
목적：검험의보관계전이접속과정시부존재성본전가화역향선택행위적이론가설，병평고기대의보기금적영향。방법：운용A시의보계통2011-2012년전이접속수거，대전입조화전출조각변량적차이분별진행잡방검험화t검험，운용다원회귀분석탐색문진화주원보소비용적영향인소。결과：잡방검험표명，전입조여전출조재년령화환유문진만성병화문진특수질병방면존재현저차이，저설명전이접속과정존재역향선택행위；t검험표명，전입조여전출조재인균주원비용급인균주원보소비용방면유현저차이；다원회귀분석현시，년령화환문진만성병화문진특수질병대문진급주원보소비용유현저영향。정책분석표명，의보기금존재전가성본적규정。결론：유우건강이민효응화풍험선택적작용，전입조적문진화주원비용대의보기금적영향병불대，지방의보기금가이진일보집행전이접속정책。
Objectives:This paper tested the hypothesis of adverse selection and cost shift in the implementa -tion of health insurance portability policy and evaluated the impact to metropolitan health insurance funds .Methods:With data from health insurance information system in A city ,we used chi-square and t-test to test the variations be -tween transferredi-n group and transferred -out group, and we used multiple regression to explore the factors affecting reimbursement of outpatient costs and inpatient costs .Results:The chi-square test indicated that age and chronic dis -eases between transferred-in group and transferred-out group was statistically significant , and this proved that adverse selection existed in the health insurance portability .The t-test indicated that inpatient cost per capita and reimburse-ment of inpatient costs per capita between transferred i-n group and transferred -out group statistically significant.Mul-tiple regressions indicated that age and chronic diseases significantly affected reimbursement of outpatient and inpatient costs.Policy analysis showed that health insurance funds had rules of shift cost .Conclusion:Because of the effect of healthy migrants and risk-selection , the outpatient and inpatient costs of the transferred i-n group did not greatly influ-ence medical insurance funds .Therefore , local government should implement the portability policy boldly .
