“互联网+”医保直接结算机制的多维影响及微观机理研究：基于医疗服务需求行为及人口流动适应性视角

“互联网+”医保直接结算机制用“数字”服务民生，是重要的时代命题。为剖析互联网与医保结算机制深度融合对参保个体的多维影响及其微观机理，本研究基于异地就医和互联网医疗直接结算情境，一是基于反事实分析框架考察结算机制的便捷效果；二是采用三阶段联立probit模型、样本选择差分模型和PSMDID模型评估结算机制对异地医疗需求行为的影响；采用两部模型、PSM模型评估其对互联网医疗需求的影响；并应用ordered logit模型衡量其健康改善效应以解答医疗需求释放与扩张的权衡问题；三是使用递归联立模型检验直接结算机制的人口流动适应性和异质性影响；四是将贝克尔的时间分配模型引入本研究以剖析“互联网+”医保直接结算通过降低时间成本和货币成本的协同效应释放医疗服务需求的机制机理，并以收入作为中介变量，通过中介效应模型加以检验。本研究可为进一步强化我国“互联网+”医保政策的实施提供有说服力的理论和实证依据。

It is an important proposition of the time that the “Internet +” medical insurance direct settlement mechanism uses digitization to serve people's livelihood.In order to analyze the multi-dimensional influence and micro mechanism of the deep integration of Internet and medical insurance settlement mechanism on the insured individuals, this study is based on the situation of remote medical treatment and Internet medical direct settlement，The first is due to the convenient effect of counterfactual analysis framework investigating “Internet +” medical insurance settlement mechanism.The second is to use a Three-Stage Simultaneous Probit Model，Sample Selection Difference Model and PSMDID Model to evaluate the impact of the settlement mechanism on the demand for medical services；use two-part model and PSM model to evaluate the impact of the settlement machanism on the demand for internet medical care;and applies the Ordered Logit Model to measure its health improvement effect to answer the trade-off between the release and expansion of medical demand.The third is to use the Recursive Simultaneous Model to test the adaptability and heterogeneity of the population mobility in the "Internet +" medical insurance settlement service mechanism.The fourth is that the study introduces Becker's Time Distribution Model to analyze the mechanism of "Internet +" medical insurance releasing medical service demand through the synergistic effect of reducing time cost and currency cost, and take income as intermediary variable, and test it by Intermediary Effect Model .This study can provide convincing theory and empirical evidence for further strengthening the implementation of China's "Internet +" medical insurance policy.