大城市医保转移接续：公平性、选择性与结果--以广东省A市为例

摘要

Objectives:This paper tested the hypothesis of adverse selection and cost shift in the implementa -tion of health insurance portability policy and evaluated the impact to metropolitan health insurance funds .Methods:With data from health insurance information system in A city ,we used chi-square and t-test to test the variations be -tween transferredi-n group and transferred -out group, and we used multiple regression to explore the factors affecting reimbursement of outpatient costs and inpatient costs .Results:The chi-square test indicated that age and chronic dis -eases between transferred-in group and transferred-out group was statistically significant , and this proved that adverse selection existed in the health insurance portability .The t-test indicated that inpatient cost per capita and reimburse-ment of inpatient costs per capita between transferred i-n group and transferred -out group statistically significant.Mul-tiple regressions indicated that age and chronic diseases significantly affected reimbursement of outpatient and inpatient costs.Policy analysis showed that health insurance funds had rules of shift cost .Conclusion:Because of the effect of healthy migrants and risk-selection , the outpatient and inpatient costs of the transferred i-n group did not greatly influ-ence medical insurance funds .Therefore , local government should implement the portability policy boldly .%目的：检验医保关系转移接续过程是否存在成本转嫁和逆向选择行为的理论假设，并评估其对医保基金的影响。方法：运用A市医保系统2011-2012年转移接续数据，对转入组和转出组各变量的差异分别进行卡方检验和t检验，运用多元回归分析探索门诊和住院报销费用的影响因素。结果：卡方检验表明，转入组与转出组在年龄和患有门诊慢性病和门诊特殊疾病方面存在显著差异，这说明转移接续过程存在逆向选择行为；t检验表明，转入组与转出组在人均住院费用及人均住院报销费用方面有显著差异；多元回归分析显示，年龄和患门诊慢性病和门诊特殊疾病对门诊及住院报销费用有显著影响。政策分析表明，医保基金存在转嫁成本的规定。结论：由于健康移民效应和风险选择的作用，转入组的门诊和住院费用对医保基金的影响并不大，地方医保基金可以进一步执行转移接续政策。