基于UHC视角的大病医疗保险补偿模式动态优化及基金支出规模研究

本研究利用大病医疗保险这一自然干预手段，与前期项目有效衔接，节省了基线调查成本，提高了效率。以WHO的UHC框架评估中西部农村大病医疗保险补偿模式，分析其与新农合、医疗救助的联合保障效应，并从UHC视角对其功能进行定位。然后结合大病患者医疗费用分布特点，综合运用限制性帕累托分布法、非参数核密度估计法等多种精算模型建立大病医疗保险损失分布函数；对大病医保前后的面板数据综合运用PSM-DID方法和Probit模型预测不同补偿模式参数下大病患者的服务利用，进一步构建“补偿参数—UHC保障效应—基金支出规模”之间的联动关系模型。最后运用增量成本效果分析评估不同补偿模式的补偿效率，确定动态优化大病医疗保险补偿模式和基金支出规模的方法。本研究不仅拓展了这些方法在卫生领域运用的广度和深度，而且为有限筹资水平下科学选择适宜的大病医疗保险补偿模式提供了理论和实践依据，以促进我国城乡医疗保障制度的不断完善。

This study applies a natural intervention—Catastrophic Health Insurance and effectively combine with previous projects，which will save the cost of baseline study and improve study efficiency. Based on the UHC framework of WHO, this study will evaluate different reimbursement modes of Catastrophic Health Insurance in rural areas of Midwest China, analysis the joint effects of Catastrophic Health Insurance with New Rural Cooperative Medical Scheme and Medical Financial Assistance and position the function of Catastrophic Health Insurance from the Perspective of UHC. Then, based on the distribution characteristics of patients’ health expenditure, we will build a loss distribution function of Catastrophic Health Insurance by limited Pareto distribution method and the Kernel density estimate. Besides, we will analyze the panel data before and after the implementation of Catastrophic Health Insurance by PSM-DID method and the Probit model in order to forecast the service utilization of catastrophic patients under different reimbursement pattern parameters and further to build the correlation among reimbursement parameters, the UHC security effect and the scale of fund expenditure. Finally, by the method of incremental cost-effective analysis, this study will evaluate reimbursement efficiency of different reimbursement models and build a method to dynamically optimize Catastrophic Health Insurance reimbursement modes and the scale of fund expenditure dynamically. This study will not only expand the breadth and depth of these methods, but also provide theoretical and practical basis for scientifically selecting proper reimbursement modes of Catastrophic Health Insurance, therefore perfecting urban and rural medical security in China.