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利用全国90家公立医院在2004年至2011年的运行数据,本文研究了中国实施全民医保的全局效应。由于在实施全民医保政策(2006年)之前,各地区医疗保险覆盖率存在差异,因此不同地区受全民医保政策的影响程度不同。本文利用这一自然实验,采用双重差分模型(DID),比较了不同地区的公立医院的医院服务量、医疗费用以及资源供给在实施全民医保政策之后的变化趋势。本文发现:第一,实施全民医保提高了医疗服务的使用量;第二,全民医保大幅度增加了医疗总费用,特别是药品费用和检查费用;第三,全民医保刺激了医院床位数增加和固定资产投资。以上结果表明,医疗保险对患者行为和医疗服务供给方会同时产生影响。这一发现有助于理解中国医疗费用快速上涨的机制,对控制医疗费用过快增长具有政策启示意义。
Utilizing the operational data of 90 public hospitals in China from 2004 to 2011, this paper studies the global effect of universal health coverage in China. Since there are differences in the coverage of medical insurance in various regions before the implementation of universal health care policy (2006), the impact of universal health insurance policies in different regions is different. Using this natural experiment, this paper uses a double-difference model (DID) to compare trends in hospital services, health care costs, and resource availability in public hospitals in different regions after universal health care policy is implemented. This article found that: First, the implementation of universal health insurance to improve the use of medical services; Second, universal health insurance substantially increased the total cost of medical care, especially drug costs and inspection costs; Third, universal health insurance has stimulated the increase in hospital beds and Investment in fixed assets. The above results show that medical insurance affects patient behavior and providers simultaneously. This finding helps to understand the mechanism of rapidly rising medical costs in China and has policy implications for controlling the excessive growth of medical costs.