在人口大规模流动常态化的社会背景下,异地就医直接结算作为提升医保公共服务效能的政策创新,满足流动人口就医需求的同时也充当着适应人口流动的重要保障机制。本文选取中国健康与养老追踪调查数据,采用Logit模型、PSM模型及中介效应模型对我国异地就医直接结算的人口流动适应性及作用机制进行实证评估。研究发现,随着医保异地就医直接结算开展范围的扩大,一定程度上打破了传统医保的“枷锁”效应,更加适应人口流动。机制分析表明,异地就医直接结算政策通过增强医保待遇可携带性适应人口流动,具体表现为减轻异地就医人员的间接医疗成本、缩短其异地往返的通勤距离和减少垫资成本。医保异地就医直接结算对健康状况好、45岁以下及60岁以上、工作类型为个体或私营、收入较高者等群体的流动具有更好的适应效果。
Abstract
Under the social background of the normalization of large-scale population flow, the direct settlement of medical treatment in different places, as a policy innovation to improve the efficiency of public medical insurance services, responds to the medical needs of the floating population and acts as an important guarantee mechanism to adapt to population flow. Using the data of CHARLS, this paper uses the Logit model, PSM model and mediating effect model to empirically evaluate the adaptability and mechanism of direct settlement of medical insurance in different areas of China on population mobility. The study found that with the expansion of direct settlement for medical treatment in different places, it has to some extent broken the shackle effect of traditional medical insurance and can be better adapted to population mobility. The analysis shows that the policy of direct settlement of medical treatment in different places adapts to population mobility by enhancing the portability of medical insurance benefits, which is manifested in reducing the indirect medical costs of people seeking medical treatment in different regions, shortening their commuting distance between different regions, and reducing payment in advance. The direct settlement of medical insurance for medical treatment in different regions has a better adaptability to the mobility of groups with good health conditions, under the age of 45 and over 60, as well as those with individual or private work types and higher incomes.
关键词
异地就医直接结算 /
人口流动适应性 /
待遇可携带性 /
中介效应
Key words
direct settlement of medical treatment in different places /
adaptability of population mobility /
portability of benefits /
mediating effect
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] ROSENMOLLER M, MCKEE M, BAETEN R, et al.Patient mobility in the European Union: learning from experience[M].World Health Organization Regional Office for Europe, 2006.
[2] MADRIAN B C, Employment-based health insurance and job mobility: is there evidence of job lock?[J].Quarterly journal of economics, 1994,109(2): 27-54.
[3] GRUBER J, MADRIAN B.Health insurance and job mobility: the effects of public policy on job-lock[J].Industrial and labor relations review, 1994,48(1):86-102.
[4] BANSAK C, RAFAEL S.The state children's health insurance program and job mobility: identifying job-lock among working parents in near-poor households[J].Industrial and labor relations review,2008,61(4): 564-579.
[5] CHUTE B,WUNNAVA P.Is there a link between employer-provided health insurance and job-mobility? evidence from NLSY79[J].Open journal of human resource management, 2018,11(1):38-52.
[6] KAPUR K.The impact of health on job mobility: a measure of job lock[J].Industrial and labor relations review,1998, 51(2): 282-298.
[7] GRUBER J, MADRIAN B.Health insurance, labor supply, and job mobility: a critical review of the literature[R].NBER working papers, 2002.
[8] 秦雪征,郑直.新农合对农村劳动力迁移的影响:基于全国性面板数据的分析[J].中国农村经济,2011 (10):52-61.
[9] 孟颖颖,张孝栋,王静.“锁定”与“回拉”:医疗保险制度对流动人口居留意愿的影响[J].东北大学学报(社会科学版),2021,23(04):67-75.
[10] 王翠琴,林潇.社会基本医疗保险对农民工就业流动的影响研究——基于居民医保和职工医保比较的视角[J].贵州财经大学学报,2023(02):83-92.
[11] 林龙飞,陈传波.城乡居民医保参与对自雇流动人口城市融入的影响研究[J].城市问题, 2021(04):87-93.
[12] 张孝栋,张蕾,孟颖颖.住院费用跨省直接结算对农民工居留意愿的影响——来自准自然实验的证据[J].兰州学刊,2023(3):112-125.
[13] 崔仕臣.社会医疗保险便携性机制探析[J].医学与社会,2011,24(01):51-53.
[14] 秦立建,杨倩,黄奕祥.农民工基本医疗保险异地转接研究述评[J].中国卫生经济,2015,34(02):17-20.
[15] 宁满秀,刘进.新型农村合作医疗制度对农户外出务工地点选择的影响研究[J].财经论丛,2014(04):41-46.
[16] 周钦,刘国恩.医保受益性的户籍差异——基于本地户籍和流动人口的研究[J].南开经济研究,2016 (01):77-92.
[17] 王震.从省内到跨省,急需信息“高速公路”[J].中国卫生,2018(10):33-34.
[18] 孙三百,黄薇,洪俊杰.劳动力自由迁移为何如此重要?——基于代际收入流动的视角[J].经济研究,2012,47(05):147-159.
[19] 林振威,吴风琴,程斌.点对点跨省异地就医直接结算的成效分析[J].经济研究导刊,2020(03):113-116.
[20] BECKER G S.A theory of the allocation of time[J].The economic journal, 1965,75(9):493-517.
[21] 徐琴.省域发展的空间逻辑——兼论"强省会"战略的地方实践[J].现代经济探讨,2020, 462(06):113-116.
[22] 黄徐亮,徐海东,倪鹏飞,等.长三角地区产业转移特征及其影响因素[J].经济地理,2023,43(01):124-132.
[23] 陈希琳.走好新阶段加快建设交通强国之路——交通运输部综合规划司答《经济》记者问[J].经济,2023(06):14-18.
[24] 孙文凯.中国的户籍制度现状、改革阻力与对策[J].劳动经济研究,2017,5(03):50-63.
[25] RUBIN DB.Estimating causal effects of treatments in randomized and nonramzed studies[J].Journal of eduaction psychology, 1974, 66(5): 688-701.
[26] 温忠麟,叶宝娟.中介效应分析:方法和模型发展[J].心理科学进展,2014,22(05):731-745.
基金
国家自然科学基金项目“'互联网+'医保直接结算机制的多维影响与微观机理研究：基于医疗服务需求行为及人口流动适应性视角”（72064031）; 内蒙古自治区“高等学校青年科技人才发展项目”（NJYT24015）
