基本医保制度空间分割如何影响待遇结果公平:来自住院基金支付比例的省际差异证据OA

Objective To examine the regional differences in inpatient fund payment ratios and their influencing factors,and provide theoretical and practical evidence for improving the pooling level of basic medical insurance and promoting equity in benefit outcomes.Methods Using data of inpatient fund payment ratio of basic medical insurance for 30 provincial-level administrative regions in China from 2020 to 2023,the Dagum Gini coefficient was employed to measure the level and structural characteristics of regional differences in inpatient fund payment ratios.A relational-data mechanism model was constructed.And the Quadratic As-signment Procedure(QAP)regression was applied to identify the effects of regional differences in policy environment,economic development,demographic structure,healthcare service level,and medical resource allocation.Results The inpatient fund pay-ment ratio of employee medical insurance is significantly higher than that of resident medical insurance.Benefit levels in eastern coastal provinces are generally better than those in inland regions.And expenditures are concentrated in tertiary medical institu-tions.Regional differences in inpatient fund payment ratios are relatively great for both employee medical insurance and resident medical insurance.However,the regional differences in employee medical insurance mainly stem from interregional differences,with relatively large gaps between the"East-Northeast"and"West-Northeast"regions,whereas the regional differences in resident medical insurance are mainly driven by interregional transvariation density.Interprovincial differences in factors as the share of fiscal health expenditure have significantly positive effects on interprovincial differences in benefit levels under both em-ployee medical insurance and resident medical insurance,whereas average length of hospital stay and the number of health techni-cians per 10,000 population have significantly negative effects on both schemes.Conclusion Regional differences in inpatient fund payment ratios under basic medical insurance exhibit both institutional and structural characteristics.The promotion of equity in benefit outcomes requires raising the pooling level,strengthening fiscal transfer payments,balancing in medical resource alloca-tion,and standardizing policy implementation.