基于福利效应理论的城乡基本医疗保险最优补偿和可持续筹资机制研究

With the rapid increase in health financing and premium subsidy, the generosity of basic social health insurance, including New Cooperative Medical Scheme in rural areas and Urban Resident Basic Health Insurance in urban areas, has been rising. And how to set optimal coinsurance and financing level has been the key issue in the design of basic health insurance. Knowledge of the utility function and the parameter values that determine medical spending elasticity can be combined to design the optimal insurance policy. The optimal health insurance should balance the utility benefits of greater risk-sharing cross people against the moral hazard costs incurred, achieving social welfare for the whole population..This study will apply the welfare effect theory to construct the social welfare function of health insurance, which can be seen the objective function for all individuals and society. The optimal coinsurance and financing level will be modeled to maximize the social welfare due to health insurance. At the same time, the financing level must be adjusted to the level of economic development and other influencing factors. According to the macro factors, the optimal risk adjustment model is used to estimate the appropriate financing level..Both secondary data and field surveys are used to estimate the optimal coinsurance and appropriate financing level in empirical research. Secondary data is collected about 2003-2013 macroeconomic, government revenue, aging and other information. The field survey will be carried out in six counties/cities from two provinces, and the information collected is as follow: health insurance information in 2003-2013 years for all counties/cities in two provinces, health insurance information system database in 6 counties/cities, in-depth interviews, and household surveys. .This project is the systematic study on the optimal coinsurance and financing level for basic health insurance, and will provide a scientific evidence to design the optimal health insurance in China.

探索建立与经济发展水平相适应的基本医疗保险可持续性筹资机制是深化医药卫生体制改革的迫切要求。本研究采用理论和实证研究的方法，构建理论模型测算基本医疗保险的最优补偿和筹资水平，结合我国经济发展水平设计可持续的基本医疗保险筹资机制和补偿水平调整策略。理论研究以福利效应理论为基础，构建基本医疗保险的社会福利效应函数，在社会总福利最大化目标下构建基本医疗保险最优补偿水平模型和适宜筹资水平模型。实证研究采用二手资料和现场调查相结合的方法：二手资料主要收集2003-2013年的宏观经济、财政等信息；现场调查将在东西部2省4个农村县和2个城市开展，包括2省所有县市的2003-2013年城乡基本医疗保险运行情况，6县市基本医疗保险信息系统数据库，财政、卫生行政和基本医疗保险管理机构访谈，家庭调查。本课题系统地对我国基本医疗保险制度的最优补偿水平和可持续性筹资机制进行研究，将为优化我国医疗保障制度设计提供理

探索建立与经济发展水平相适应的基本医疗保险最优补偿水平和可持续性筹资机制是深化医药卫生体制改革的迫切要求。本研究采用理论和实证研究相结合的方法，构建理论模型，通过实证研究测算基本医疗保险的最优补偿水平和适宜筹资水平。.理论研究部分，通过平衡医疗保险风险分散的福利改善作用和道德风险的福利损失作用来综合测量基本医疗保险的社会总福利效应；并以此为基础构建基本医疗保险最优补偿水平理论模型，发现最优补偿水平取决于三类参数：卫生服务需求的价格弹性、医疗风险的成本、补偿政策范围外的服务成本；然后构建医疗保险的适宜筹资水平模型。.实证研究部分，通过全国层面的调查数据和本课题收集数据分析发现：1）我国基本医疗保险增加居民卫生服务利用概率及其对所利用服务的知晓情况，增加对公立卫生服务的选择，改善居民福利。2）医疗保险福利受益分布不公平，需要促进医疗保险跨地区携带并防止人口流出地政府对流入地政府的逆向补贴，提升保险福利受益的公平性 。3）新农合补偿比例每增加1个百分点，住院服务概率增长7.5%，次均总费用增长1%；家庭总支出中住院医疗支出占比降低0.3个百分点。据此计算得出，新农合最优补偿比例区间为70-80%。4）居民医疗保险支付意愿在260-420之间，并且受到保险政策知晓度和财政补贴等方面的影响，可以作为保险筹资水平制定的依据。当前居民对基本医疗保险的支付意愿为260元；对保险政策的知晓显著提升居民支付意愿，了解政策后支付意愿提升至300元；当政府补贴由500元增至1000元，居民支付意愿仅从320元增至420元。另外，流动人口、穷人和健康状况较差的弱势人群处在医疗保险体系的边缘，更不可能被医疗保险所覆盖。