摘要
基本医疗保险制度作为医疗保障体系的重要组成部分,对医疗费用的管理具有重要影响。本研究通过理论与实证研究,探讨了费用分担机制、支付方式改革及医疗保险类型对医疗费用增长的影响。研究发现,费用分担机制和支付方式改革对医疗费用不合理增长具有显著的抑制作用,职工医保与城乡居民医保因筹资水平、费用分担结构及监管能力的差异,在费用管理效果上呈现制度性分化。然而,信息不对称和道德风险问题削弱了医疗保险制度的费用管理效果。异质性分析表明,费用分担机制和支付方式改革的效果在不同收入群体和地区之间存在显著差异,高收入群体和经济发达地区的政策效果更为显著。基于研究结论,本文提出了优化费用分担机制、推进支付方式改革、加强医疗服务监管以及提高医疗保险制度公平性等政策建议,为优化医疗保险制度设计、提高医疗费用管理水平提供了理论依据和实证支持。
The basic medical insurance system,as a crucial component of the healthcare security system,plays a significant role in managing medical costs.This study explores the impact of cost-sharing mechanisms,payment method reforms,and types of medical insurance on the growth of medical costs through theoretical analysis and empirical research.The findings reveal that cost-sharing mechanisms and payment method reforms significantly inhibit the growth of medical costs.Employees’basic medical insurance and urban and rural residents’basic medical insurance demonstrates institutional differentiation in cost management due to differences in fundraising levels,cost-sharing structures,and supervision capabilities.However,issues of information asymmetry and moral hazard undermine the effectiveness of the medical insurance system in managing costs.Heterogeneity analysis indicates that the effects of cost-sharing mechanisms and payment method reforms vary significantly across different income groups and regions,with more prominent policy effects among high-income groups and economically developed regions.Based on the research conclusions,policy recommendations are proposed,including optimizing cost-sharing mechanisms,promoting payment method reforms,strengthening medical service supervision,and enhancing the fairness of the medical insurance system.This study provides important theoretical and empirical support for optimizing the design of the medical insurance system and improving the management of medical cost.
出处
《中国医疗保险》
2025年第5期88-95,共8页
China Health Insurance
基金
教育部产学合作协同育人项目“基于数据驱动教学模式的科研写作培训策略研究”(231107624105859)。
关键词
基本医疗保险制度
医疗费用管理
费用分担机制
支付方式改革
basic medical insurance system
medical cost management
cost-sharing mechanism
payment method reform
作者简介
通讯作者:江亚锋,南昌理工学院经济管理学院讲师,E-mail:1572450499@qq.com。
