本文選題：兩部模型 + 醫(yī)療保險制度　； 參考：《廈門大學》2014年碩士論文

【摘要】：隨著世界各國衛(wèi)生費用的不斷上漲以及醫(yī)療改革的不斷推進,醫(yī)療保險制度通過降低就醫(yī)的經(jīng)濟門檻,增加醫(yī)療保障服務的可及性,減輕居民家庭醫(yī)療費用的負擔,釋放消費需求,已在世界各地形成共識。目前,我國基本醫(yī)療保險體系已基本實現(xiàn)“全民醫(yī)�！�,并進入轉(zhuǎn)變服務質(zhì)量的重要改革階段。本文引入兩部模型來研究醫(yī)療保險對家庭住院醫(yī)療需求和家庭消費的作用,旨在提出有利于完善全民醫(yī)保體系的政策性建議,進一步促進全民醫(yī)保體系的效率與公平。 首先,本文闡述了論文的選題背景、研究內(nèi)容及論文框架。然后,本文以我國衛(wèi)生醫(yī)療支出與全球衛(wèi)生醫(yī)療支出的發(fā)展現(xiàn)狀、我國居民醫(yī)療支出及其占消費支出比例的現(xiàn)狀為背景,概括了我國全民醫(yī)保體系的三個發(fā)展階段。接著,本文梳理了國內(nèi)外相關(guān)文獻綜述,引入用于分析全民醫(yī)保體系下醫(yī)療服務利用的兩部模型,基于廈門市居民家庭電話調(diào)查微觀數(shù)據(jù)并利用兩部模型及其擴展方法,來分別考察我國全民醫(yī)保背景下居民家庭住院醫(yī)療需求和應對大筆醫(yī)療支出時家庭消費結(jié)構(gòu)選擇策略。 從方法方面來看,在比較兩部模型和廣義線性模型的家庭住院醫(yī)療需求實證分析基礎上,本文建立了由兩部模型擴展而得的三部模型,并在大筆醫(yī)療支出下家庭消費結(jié)構(gòu)選擇實證分析中得到較好的擬合結(jié)果。從應用方面來看,以全民醫(yī)保為背景,以家庭為單位,本文考察了家庭住院醫(yī)療需求兩個決策過程的影響因素及其作用程度,并比較深入地分析了大筆醫(yī)療支出下家庭消費結(jié)構(gòu)選擇的時序決策過程及其影響因素。本文的實證研究主要得到以下幾個結(jié)論：(1)全民醫(yī)保體系確實對居民家庭基本生活及身體健康起到一定的保障作用,但基本醫(yī)保對住院次數(shù)的醫(yī)療需求作用顯著大于有慢性病患者,收入越高的家庭越有可能決定住院,基本醫(yī)保所釋放的新增醫(yī)療需求有可能是過度的、非有效的醫(yī)療消費；(2)住院次數(shù)多的家庭收入平均水平較低,有慢性病患者家庭的住院醫(yī)療需求更高,作為全民醫(yī)保的兜底和補充部分,涵蓋重特大病或慢性病的城鄉(xiāng)醫(yī)療救助體系和大病補助醫(yī)療保險有著重要的推廣意義；(3)在我國特有的城鄉(xiāng)二元化背景下,農(nóng)村家庭受大筆醫(yī)療支出的影響更大,并且,農(nóng)村和城鎮(zhèn)家庭在決定住院的醫(yī)療需求上沒有顯著差異,農(nóng)村家庭對住院次數(shù)的醫(yī)療需求卻顯著高于城鎮(zhèn)家庭,農(nóng)村家庭在保障水平較低情況下還需要面對醫(yī)療效率問題。 最后,本文進一步地總結(jié)了家庭住院醫(yī)療需求及消費結(jié)構(gòu)選擇實證研究的分析結(jié)果,對我國全民醫(yī)保體系的效率和公平問題提出相關(guān)的政策性建議,并對未來進一步的研究進行了展望。
[Abstract]:With the rising of health costs and the promotion of health care reform in the world, the medical insurance system reduces the burden of medical expenses on households by lowering the economic threshold of medical treatment, increasing the accessibility of medical security services, and reducing the burden of medical expenses on households. The release of consumer demand has reached consensus around the world. At present, the basic medical insurance system of our country has basically realized "universal medical insurance" and entered the important reform stage of transforming service quality. This paper introduces two models to study the effect of medical insurance on family hospitalization medical needs and household consumption. The purpose of this paper is to put forward some policy suggestions that are conducive to the improvement of universal medical insurance system and to further promote the efficiency and fairness of universal medical insurance system. First of all, this paper describes the background of the topic, research content and the framework of the paper. Then, based on the status quo of health care expenditure in China and global health care expenditure, and the current situation of medical expenditure and its proportion in consumption expenditure, this paper summarizes the three stages of development of national health insurance system in China. Then, this article combs the domestic and foreign related literature review, introduces two models used to analyze the utilization of medical services under the universal health insurance system, based on the microscopic data of the household telephone survey in Xiamen, and uses the two models and their extended methods. To investigate the residents' hospitalization medical needs and household consumption structure selection strategies in the context of universal health insurance in China. From the point of view of method, on the basis of comparing the two models with the generalized linear model, this paper establishes a three-part model, which is extended by the two models. In the empirical analysis of household consumption structure selection under large medical expenditure, a good fitting result is obtained. From the aspect of application, taking the universal health insurance as the background and the family as the unit, this paper examines the influencing factors and the degree of action of the two decision-making processes of the family hospitalization medical needs. The decision process and its influencing factors of household consumption structure selection under large medical expenditure are analyzed in depth. The empirical study of this paper mainly draws the following conclusions: (1) the universal health insurance system does play a certain role in protecting the basic life and health of the residents. However, the effect of basic medical insurance on the number of hospitalizations is significantly greater than that of patients with chronic diseases, and the families with higher income are more likely to decide hospitalization, and the new medical needs released by basic medical insurance may be excessive and ineffective. (2) the average income of families with more frequent hospitalizations is lower, and families with chronic diseases have higher hospitalization medical needs, which is regarded as the bottom and supplementary part of universal health insurance. The urban and rural medical assistance system covering serious and serious diseases or chronic diseases and the medical insurance subsidy for major diseases have important significance in popularizing; (3) in the context of the dualization of urban and rural areas, rural households are more affected by large medical expenses, and, There is no significant difference between rural and urban families in determining the medical needs of hospitalization, but the medical demand of rural families is significantly higher than that of urban families, and rural families still have to face the problem of medical efficiency in the case of low security level. Finally, this paper further summarizes the results of the empirical study on the choice of family hospitalization medical needs and consumption structure, and puts forward relevant policy recommendations on the efficiency and fairness of the universal health care system in China. The future research is prospected.
【學位授予單位】：廈門大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R197.1;F842.684;F126.1

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