大病保险是否改善了医疗弱势群体的保障状况——以老年人和低收入群体为例被引量：17

Has China’s Critical Illness Insurance Improved the Situation of the Vulnerable Groups: Case Studies of the Elderly and Low-income Groups

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摘要基于样本城市的医疗保险抽样数据,以弱势群体中的老年人和低收入者为重点关注对象,对大病保险是否改善了弱势群体的保障状况进行实证分析。研究发现,作为防止居民因病致贫和因病返贫的重要机制,大病保险显著促进了这两类群体的医疗服务利用水平,提高了其住院补偿水平,但其自付费用和自费负担并未能够有效降低,且灾难性支出发生率存在上升趋势。"不合规"医疗费用的过快上涨、大病保险"门槛"设置的不合理以及重大疾病的年轻化趋势可能是主要原因。为此,应综合考虑病种和医疗费用,对重大疾病进行重新界定,适当扩展"合规医疗费用"的范围,精准瞄准弱势群体确定差异化的起付线,并下大力气控制医疗费用的不合理增长。 Based on sample data of health insurance from selected cities,with a focus on the elderly and low-income people,an empirical analysis was conducted to determine whether critical illness insurance has improved the protection status of vulnerable groups. It is found that,as an important mechanism for preventing residents from falling into and returning poverty due to illness,critical illness insurance has significantly contributed to the utilization of medical services and upgraded their reimbursement level,while the amount of out-of-pocket expenses( OOP) and their economic burden have not been effectively reduced,and there is an upward trend in the incidence of catastrophic expenditures. It may be the rapid increase of medical costs outside the scope of policy,the unreasonable setting of the threshold for critical illness insurance,together with the youth-oriented tendency of the incidence rate of critical illnesses that might contribute to the unexpected findings. To solve the problems,it is argued that the definition of "critical illness"should be redefined by considering both the disease types and the amount of medical care expenditure,to expand the scope of expenditures with the policy,to target on the disadvantaged groups accurately to set differentiated deductibles,and especially to control effectively the unreasonable increases in medical expenses.

作者李亚青罗耀 LI Ya-qing;LUO Yao(School of Finance,Guangdong University of Finance&Economics,Guangzhou 510320;School of Information Studies,Guangdong Mechanical and Electrical Polytechnic,Guangzhou 510550,China)

机构地区广东财经大学金融学院广东机电职业技术学院信息学院

出处《广东财经大学学报》 CSSCI 北大核心 2020年第6期100-110,共11页 Journal of Guangdong University of Finance & Economics

基金国家社会科学基金年度项目(18BJY215)。

关键词医疗保障大病保险弱势群体老年人低收入群体医疗服务利用补偿水平疾病经济负担 medial security critical illness insurance vulnerable groups the elderly low-income groups medical service utilization reimbursement economic burden of illness

分类号 F840.684 [经济管理—保险]