Wagstaff Adam, Lindelow Magnus
The World Bank, 1818 H Street NW, Washington, DC 20433, USA.
J Health Econ. 2008 Jul;27(4):990-1005. doi: 10.1016/j.jhealeco.2008.02.002. Epub 2008 Feb 9.
We analyze the effect of insurance on the probability of an individual incurring 'high' annual health expenses using data from three household surveys. All come from China, a country where providers are paid fee-for-service according to a schedule that encourages the overprovision of high-tech care and who are only lightly regulated. We define annual spending as 'high' if it exceeds a threshold of local average income and as 'catastrophic' if it exceeds a threshold of the household's own per capita income. Our estimates allow for different thresholds and for the possible endogeneity of health insurance (we use instrumental variables and fixed effects). Our main results suggest that in all three surveys health insurance increases the risk of high and catastrophic spending. Further analysis suggests that this is due to insurance encouraging people to seek care when sick and to seek care from higher-level providers.
我们利用三项家庭调查的数据，分析了保险对个人产生“高额”年度医疗费用可能性的影响。所有数据均来自中国，在中国，医疗服务提供者按服务收费，收费标准鼓励过度提供高科技医疗服务，且监管力度较小。如果年度支出超过当地平均收入阈值，我们将其定义为“高额”；如果超过家庭自身人均收入阈值，则定义为“灾难性”。我们的估计考虑了不同的阈值以及医疗保险可能存在的内生性（我们使用了工具变量和固定效应）。我们的主要结果表明，在所有三项调查中，医疗保险都会增加高额和灾难性支出的风险。进一步分析表明，这是因为保险鼓励人们生病时就医，并寻求更高级别的医疗服务提供者的治疗。
