CAJ | 학술논문

文章基于两部模型,利用从广东省A市城镇职工基本医疗保险信息管理系统中提取的微观数据,考察了参保机会及保障水平对该市三个地区参保人医疗服务利用及其均等化的影响。主要结论是：参保机会均等总体上能促进地区间医疗服务利用均等化,但无法从根本上解决亲富人的医疗服务利用不公平问题;实际报销比例对频率决策阶段的医疗服务利用有显著的正向影响,意味着很可能存在过度医疗,而起付标准对参保人理性就医的约束力有限;特殊病种门诊医疗服务利用在三个地区之间基本实现了均等化,但触发决策阶段的住院医疗服务利用存在地区间不均等,地区间收入水平和住院医疗服务利用率的双重差异是引起这种不均等的主要原因。
문장기우량부모형,이용종광동성A시성진직공기본의료보험신식관리계통중제취적미관수거,고찰료삼보궤회급보장수평대해시삼개지구삼보인의료복무이용급기균등화적영향。주요결론시：삼보궤회균등총체상능촉진지구간의료복무이용균등화,단무법종근본상해결친부인적의료복무이용불공평문제;실제보소비례대빈솔결책계단적의료복무이용유현저적정향영향,의미착흔가능존재과도의료,이기부표준대삼보인이성취의적약속력유한;특수병충문진의료복무이용재삼개지구지간기본실현료균등화,단촉발결책계단적주원의료복무이용존재지구간불균등,지구간수입수평화주원의료복무이용솔적쌍중차이시인기저충불균등적주요원인。
Based on a two-part model, this paper employs the micro data of insured individuals from the information management system of urban em- ployees＇ social health insurance in city A in Guangdong province to study the effects of the opportunity of participating in insurance and security level on the insured＇s utilization of health care services and the equality among three areas in this city. It arrives at the conclusions as follows, firstly, the equality in the opportunity of participating in insurance overall promotes in- ter-region equality in health care services, but cannot fundamentally solve the unfair pro-rich utilization of health care services; secondly, real reim- bursement ratio has a significantly positive effect on the utilization of health care services at the stage of frequency decision-making, confirming the pos- sible existence of excessive medical treatment, and deductible standard has limited constraints on the insured＇s rational utilization choice; thirdly, the utilization of special diseases outpatient health care services achieves the e- quality among the three regions, but the utilization of inpatient health care services at the stage of contact decision-making does not realize the equality among the three regions, mainly owing to the dual differences in inter-region incomes levels and the utilization rates of inpatient health care services.