城乡基本医疗保险的政府补贴与补偿方案的福利分配效应研究

项目名称： 城乡基本医疗保险的政府补贴与补偿方案的福利分配效应研究

项目编号： No.71303056

项目类型： 青年科学基金项目

立项/批准年度： 2014

项目学科： 管理科学

项目作者： 胡敏

作者单位： 复旦大学

项目金额： 20万元

中文摘要： 福利分配公平性是政府公共支出政策的重要绩效目标。作为新医改中政府最大项投入，以财政补贴支持农村居民和城市非就业居民参加城乡基本医疗保险的政策对目标人群内部福利分配公平性的改善程度尚未得到验证。本研究拟在农村居民入户调查面板数据建立的基础上，运用边际受益归属分析方法研究随着政府投入加大，该项补贴的受益归属及福利分配的动态变化。随后在医疗保险制度层面，寻找影响政府补贴福利分配结果的原因。拟选取新医改后逐步试点铺开的"门诊统筹"和"农村居民重大疾病保障"两项重要医保补偿方案，通过自然试验设计并对相关亚人群进行专项定性和定量调查，利用倍差法评估上述政策对居民服务利用、获得政府补贴水平及最终福利分布的影响；同时通过计量经济学模型模拟预测政策发展后不同人群服务需求及就医行为改变情形下受益归属的边际变化，对政策进行前瞻性评估。以此为调整和优化医疗保险补偿方案，提高政府补贴利贫效率提供政策参考。

中文关键词： 政府补贴；社会医疗保险；补偿方案；福利分配；公平性

英文摘要： Equity in welfare distribution is one of the crucial goals of the public spending. As the major investment of the China's new healthcare reform, the governments subsidize the rural population and the urban unemployed residents to get enrolled in the basic social health insurance schemes. However, with the subsidies growing fast recently, how this public spending policy changes the welfare distribution hasn't been verified and assessed. This study first intends to conduct a marginal benefit incidence analysis based on panel data from household survey to measure who benefit more from the increased subsidies. Then it further explores the distributional impacts of the insurance benefit package, which can be seen as the way in which resources translate into actual healthcare services. The natural experiment design with non-reform areas serving as control group as well as difference-in-difference methodology are adopted to evaluate the causal effects of the two different benefit designs "outpatient pooling scheme" and "catastrophic disease insurance scheme" on benefit incidence. Finally econometric models are used to simulate and estimate the marginal distributional impacts of the expansions of the two schemes on individuals and households, allowing for behavioural responses. Thus the policy recommendations for adjust

英文关键词： government subsidy；social health insurance；benefit package；welfare distribution；equity