关键词: 医疗保险, 供方道德风险, 支付方式, 双重差分法

Abstract: Payment schemes of medical insurance have an important economic effect on preventing the moral hazard of medical service providers and controlling the unreasonable growth of medical expenses. With the real medical insurance reimbursement data from the sample area,this paper uses the DID method to eliminate the effects of medical demand release,moral hazard from the demand side, and the price adjustment of medical services,to explore the pure effect of payment schemes on the moral hazard of the medical service providers and its mechanism.The results show:first, after the payment scheme of the sample changes from “payment by visits” to “payment by days of medication”,the frequency of medical visits of insured persons decreases significantly, while the average medical expenses per time,especially the Traditional Chinese Medicine,increase significantly,which leads to the total expenses keep as high as before.This finding confirms that under the payment scheme of “payment by days of medication”,the moral hazard of decomposing the number of visits from medical service providers is under control,while the moral hazard of increasing medication is increasing.What’s more,it is also indicated that under different payment schemes, medical service providers will make use of their absolute dominant position in the asymmetry of professional knowledge and patient information to realize the transformation of moral hazard,so as to safeguard their vested interests from being damaged.Finally,the patients with urban and rural residents’ medical insurance, those aged over 65,the patients who choose to visit the primary care providers,and the patients with chronic diseases are relatively more affected,indicating that the behavior of “differentiated pricing” also exists significantly.The research in this paper provides enlightenment for the improvement of payment schemes and fund supervision.

Key words: Medical Insurance, Moral Hazard of Medical Service Providers, Payment Schemes, DID