为评估城乡居民基本医疗保险（以下简称“居民医保”）省级统筹对医疗费用的影响与作用路径,并为“十五五”规划纲要提出基本实现基本医疗保险省级统筹的目标提供政策参考,本研究利用2014—2022年五期中国家庭追踪调查（CFPS）非平衡面板微观数据,运用多期双重差分和倾向得分匹配 （PSM-DID）的方法,系统评估居民医保省级统筹对医疗费用的影响与作用路径。研究发现,居民医保省级统筹显著助推医疗总费用增长,结果显示政策实施后人均医疗总费用平均每年增加4087.654元。从作用机制来看,政策通过影响需求与供给双方行为产生效果：需求方面,患者前往高等级医院就医的倾向提高,就医可及性得到改善;供给方面,住院服务替代门诊服务明显,同时报销比例下降、自付比例上升。异质性分析发现,政策效果呈现显著的区域与群体分化特征：分地区看,职工基本医疗保险（以下简称“职工医保”）省级统筹先行地区医疗费用增长得到有效缓解,而门诊费用直接结算试点地区医疗费用上涨较为显著;分群体看,居民医保省级统筹抑制了流动人口的医疗费用增长,但助推了收入水平低、60岁以上及患有慢性病群体的医疗费用增长。因此,在推进居民医保省级统筹的过程中,不仅要管控医疗费用的不合理增长,还要通过完善针对性的配套政策体系,破解统筹层级提升过程中凸显的医保治理适配性问题,保障省级统筹政策落地见效、行稳致远。

To assess the impact and mechanism of provincial-level pooling of the urban and rural residents’ basic medical insurance (hereafter referred to as “residents’ medical insurance”) on medical expenses, and to provide policy references for the goal of basically achieving provincial-level pooling of basic medical insurance as outlined in the 15th Five-Year Plan Outline, this paper employs a five-wave unbalanced panel microdata from the China Family Panel Studies (CFPS) covering the period 2014-2022. Using the multi-period propensity score matching difference-in-differences (PSM-DID) methods, we systematically evaluate the impact and mechanism of provincial-level pooling of the resident’ medical insurance on medical expenses. The empirical results show that provincial-level pooling of resident’ medical insurance has significantly promoted the growth of total medical expenses per capita, with an average annual increase of 4087.654 yuan after policy implementation. Regarding the mechanism, the policy exerts its effects by influencing behaviors of both the demand and supply sides. On the demand side, patients show a higher tendency to seek medical care in higher-level hospitals, and healthcare accessibility has been improved. On the supply side, inpatient services have notably substituted outpatient services; meanwhile, the reimbursement ratio has decreased while the out-of-pocket ratio has increased. Heterogeneity analysis reveals significant regional and group disparities in policy effects. Regionally, the growth of medical expenses has been effectively mitigated in areas where provincial-level pooling of the employees’ basic medical insurance (hereafter referred to as “employees’ medical insurance”) was implemented earlier, whereas the rise in medical expenses is more pronounced in regions piloting direct settlement of outpatient expenses. By group, provincial-level pooling of residents’ medical insurance has suppressed the growth of medical expenses among migrant populations, but boosted medical expenditure among low-income groups, people aged 60 and above, and those with chronic diseases. Therefore, in the process of advancing the provincial-level pooling of residents’ medical insurance, it is necessary not only to manage the unreasonable growth of medical expenses but also to improve the supporting policy system with targeted measures. This will help resolve the adaptability issues in medical insurance governance that emerge with the elevation of pooling levels, ensuring the effective and sustainable implementation of the provincial-level pooling policy.