医疗保险基金的安全对卫生公平至关重要。在中国,医疗保险基金支出逐年大幅增加,地方医疗保险基金收支平衡难以维持。实现医疗保险负担的公平分配,中央政府必须不断增加转移支付,造成中央财政资源分配的区域不公平。本文探讨了中央转移支付对医保基金收支平衡的影响,有影响力的机制,以及地方政府的战略行为。
首先,构建了中央与地方政府间的动态博弈模型,分析了中央转移支付对地方医保基金收支平衡的影响机制。然后,基于2004-2014年中国28个省级行政区的省级面板数据,进行了实证检验。构建了空间回归模型,并将邻近省份上年度取得的转移支付作为工具变量。
中央转移支付导致地方政府的战略行为,导致地方医疗保险基金支出增加和平衡率降低。此外,中央转移支付表现出“路径依赖”。中央转移支付对地方新农合基金收支平衡率有显著的负面影响。地方政府补贴和人均GDP对地方新农合基金结存率具有显著的正向影响。所获得的地方政府转移支付具有显著的空间相关性。基于NCMS数据的这项研究仍然有效。
中央转移支付诱发了地方政府的战略行为,忽视了医疗保险基金支出的监管,降低了医保基金管理和使用的效率。医疗保险基金财政资源在各省之间分配不均。加强地方政府的监督能力和主动性等措施,完善中央转移支付机制,促进西部地区经济增长,适当提高个人缴费率,可以确保医疗保险基金得到很好的使用和公平的分配。
The security of medical insurance fund is very important to health equity. In China, the expenditure of medical insurance fund has increased sharply year after year, and the balance of local medical insurance fund is difficult to sustain. To realize the equitable distribution of the medical insurance burden, the central government has to continuously increase transfer payments, which causes regional unfairness in the distribution of central financial resources. This paper explores the influence of central transfer payments on the balance of medical insurance fund, influential mechanisms, and the strategic behavior of local governments.
First, we constructed a dynamic game model between central government and local governments and analyzed the mechanism of central transfer payments affecting the balance of local medical insurance fund. Then, based on the provincial panel data of 28 provincial administrative regions in China from 2004 to 2014, an empirical test was made. The spatial regression model was constructed, and the transfer payments obtained by neighboring provinces in the previous year were taken as instrumental variables.
Central transfer payments led to strategic behaviors by local governments that resulted in increased local health insurance fund expenditures and lower balance rates. Moreover, the central transfer payments demonstrated \"path dependence\". Central transfer payments had a significant negative influence on the local NCMS fund balance rate. The local government subsidy and per capita GDP had a significant positive impact on the local NCMS fund balance rate. The obtained transfer payments of local governments had a significant space correlation. This study based on NCMS data remains valid.
Central transfer payments induced the strategic behavior of local governments, which neglected to supervise the expenditure of medical insurance fund, reducing the efficiency of medical insurance fund management and use. The financial resources of medical insurance fund are unevenly distributed among provinces. Measures such as strengthening the supervision ability and initiatives of local governments, refining the central transfer payment mechanism, promoting the economic growth of western regions, and increasing rates for individual contributions appropriately can ensure that the medical insurance fund are used well and distributed equitably.