户籍类型与城乡居民医疗服务利用——基于Andersen模型的经验分析

本文利用中国社会科学院经济研究所2018年城乡居民入户调查数据,从户籍改革角度分析户口类型改变对城乡居民医疗服务利用的影响。研究发现:与户口类型未发生改变的城乡居民相比,户口类型发生过改变(农转非)的城乡居民门急诊服务利用的可能性更高,住院医疗服务支出水平更低。从户籍改革与参保类型交互效应看,相对于户口类型未发生过改变的居民医保参保人群,户口类型发生改变(农转非)会显著提高居民医保参保人群门急诊服务利用,同时降低其住院服务利用。进一步采用PSM方法进行稳健性检验,户籍改革对提高城乡居民门急诊服务利用,降低住院医疗服务利用的结论依然成立。此外,本文还发现,直接结算提高了城乡居民门急诊和住院的就诊概率;健康自评状况越差,门急诊和住院医疗服务利用可能性越高,门急诊医疗支出、住院医疗支出和跨省异地就医支出也越高。本文认为,相对于推行基层分级诊疗制度,以户籍改革推动农村居民自由流入医疗资源更丰富的城镇地区,改革基层卫生院制度,以及改变基层医疗服务提供激励机制,可能更有助于改善农村居民健康状况。

The Household Registration Type and the Health-care Utilization of Urban and Rural Residents:Empirical Analysis Based on Anderson Model

Based on the survey data of urban and rural residents in 2018 by the Economics Institute of Chinese Academy of Social Sciences,this paper analyzes the impact of the changes in household registration type on the use of medical services for the urban and rural residents.The study found that the residents experienced changes of household registration from the rural households to the urban households are more likely to use outpatient and emergency services,and the expenditure level of inpatient medical services is lower compared with the urban and rural residents without changes.From the perspective of the interaction between household registration and social securities system,the changes of households registration can significantly increase the outpatient and emergency services,and reduce the utilization of inpatient services of the residents who have shifted to urban households comparing with the residents without changes of household registration type.Further PSM method for robustness test support the conclusion of household registration reform can increase the utilization of outpatient and emergency services and reduce the utilization of inpatient medical services.In addition,the direct settlement of medical bill increase the probability of outpatient and emergency treatment and hospitalization of urban and rural residents,and the worse the self-assessment of health,the higher possibility of outpatient and emergency treatment as well as hospitalization medical services,the higher medical expenditure of outpatient,emergency,hospitalization and cross-provincial medical services.This paper suggest that compared with the implementation of the grass-roots hierarchical diagnosis and treatment system,the reform of household registration can promote the free flow of rural residents into urban areas with more abundant medical resources may be more conducive to improve the health status of rural residents.