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文章基于两部模型,利用从广东省A市城镇职工基本医疗保险信息管理系统中提取的微观数据,考察了参保机会及保障水平对该市三个地区参保人医疗服务利用及其均等化的影响。主要结论是:参保机会均等总体上能促进地区间医疗服务利用均等化,但无法从根本上解决亲富人的医疗服务利用不公平问题;实际报销比例对频率决策阶段的医疗服务利用有显著的正向影响,意味着很可能存在过度医疗,而起付标准对参保人理性就医的约束力有限;特殊病种门诊医疗服务利用在三个地区之间基本实现了均等化,但触发决策阶段的住院医疗服务利用存在地区间不均等,地区间收入水平和住院医疗服务利用率的双重差异是引起这种不均等的主要原因。
Based on the two models, the paper uses the micro-data extracted from the basic medical insurance information management system of urban workers in A City of Guangdong Province to examine the impact of insurance opportunities and levels of protection on the utilization of medical services and their equalization Impact. The main conclusion is that the equal opportunity of insured can promote the equalization of medical service utilization in different regions, but it can not fundamentally solve the unfair problem of medical service utilization in the pro-rich. The actual reimbursement ratio has significant effect on the utilization of medical services in the frequency decision-making stage Positive effect means that there is a high possibility of over-medical treatment, and the starting-up standard has limited binding on the insured person’s rational medical treatment. The out-patient medical service utilization of special diseases basically achieves the equalization between the three regions, but triggers the decision-making The inequality in the utilization of inpatient medical services at different stages of the hospitalization period and the double difference in the inter-district income level and inpatient medical service utilization are the main causes of such inequality.