政府医疗投入与居民医疗负担——基于“补供方”与“补需方”的路径分析

《财经研究》 2022年48卷第2期 页码：123 - 137  online：2022年2月2日

政府医疗投入与居民医疗负担——基于“补供方”与“补需方”的路径分析

Government Medical Investment and Residents’ Medical Burden: Path Analysis Based on “Subsidy for the Supplier” and “Allowance for the Demander”

作者（中）：王增文, 刘庆, 胡国恒

作者（英）：Wang Zengwen, Liu Qing, Hu Guoheng

作者单位：1.武汉大学 社会保障研究中心, 湖北 武汉 430072

摘要：有效降低居民医疗负担是我国深化医疗体制改革的重要目标之一。在医疗体制改革向纵深发展的背景下，如何优化政府医疗投入路径以降低居民医疗负担事关医疗体制改革成效。文章基于2007—2017年省际面板数据，使用系统GMM方法估计“补供方”（政府面向公立医疗机构的财政投入）与“补需方”（政府面向居民的财政投入）对居民医疗负担的影响效应。结果发现：（1）两种医疗投入路径对医疗负担的影响效应截然相反，“补供方”助涨了医疗费用，加重了居民的医疗负担，而“补需方”则有效降低了负担。从贡献比看，“补供方”的助涨效应强于“补需方”的降负效应。（2）机制分析表明，“补供方”扩充了医疗资源，如增加了床位数量、医生数量和非流动资产，但在现行激励机制下，新增的医疗资源不仅产生了成本分摊效应，还被供方转化为占有消费者剩余的卖方优势，加重了居民医疗负担，甚至弱化了“补需方”的降负效应。因此，文章建议优化供给侧的补贴机制，通过调整投入流向和投入方式强化公立医疗机构的公益属性，并且推动医疗需求侧的改革，以支付方式改革遏制医生的道德风险，进一步发挥“补需方”的降费作用。

关键词：医疗负担; 财政投入; 补供方; 补需方; 系统

Summary: To reduce the burden of residents’ medical costs is the core goal of China’s medical system reform. Under the background of the deepening development of medical system reform, how to optimize the government’s medical investment path to reduce the medical burden of residents is related to the outcomes of medical system reform. However, there are few studies on the effect of specific flow direction of government medical investment on the medical burden of residents.Based on the provincial panel data from 2007 to 2017, this paper uses the systematic GMM method to estimate the effect of “subsidy for the supplier” and “allowance for the demander” on the medical burden of residents. The results show: Firstly, the two medical investment paths have opposite effects on medical burden. The “subsidy for the supplier” increases the medical expenditure and the medical burden of residents, while the “allowance for the demander” is the opposite. In terms of the contribution ratio, the boosting effect of “subsidy for the supplier” is stronger than the reduction effect of “allowance for the demander”. Secondly, the “subsidy for the supplier” increases medical resources, such as the number of beds, doctors and fixed assets, but fails to effectively reduce the medical burden of residents. The new medical resources not only produce a cost-sharing effect, but also are transformed by the supplier into the seller’s advantage of occupying the surplus of consumers, which increases the medical burden of residents by inducing demand through excessive diagnosis and treatment and excessive medication.Therefore, this paper suggests optimizing the subsidy mechanism on the supply side, strengthening the public welfare attribute of public medical institutions by adjusting the investment flow and mode, and reducing the incentives for doctors to overuse drugs and over check due to income squeeze. We should promote the reform of the medical demand side, curb the moral hazard of doctors by means of payment reform, and further give play to the role of “allowance for the demander” in reducing fees.In general, the marginal contribution of this paper is that the inclusion of “subsidy for the supplier” and “allowance for the demander” into a unified analysis framework helps to enrich the research horizon of the effect of government medical investment on the medical burden of residents. Furthermore, this paper thoroughly studies the internal mechanism of the effect of government medical investment on residents’ medical burden under different investment paths.

Key words: medical burden; financial investment; “subsidy for the supplier”; “allowance for the demander”; system GMM

DOI：10.16538/j.cnki.jfe.20211113.401

收稿日期：2021-6-24

基金项目：国家社会科学基金重点项目（21AZD072）；教育部哲学社会科学研究重大课题攻关项目（20JZD025）；中央高校基本科研业务费专项资金项目（2020AI017）

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