金融学院知识库

随着我国多层次医疗保险体系的基本建立与不断发展，国民可参与的医疗保障形式更加丰富。处于多层次医疗保险体系主体地位的基本医疗保险以“广覆盖、保基本”的特点为国民提供基本的医疗保障服务，处于补充地位的商业医疗保险以多样的产品类型、丰富的保障责任满足国民医疗保障的差异化需求。通过文献研究发现，医疗保险深刻影响着我国国民的生活方式。农村居民的就医行为一直以来备受关注，不同层次医疗保险因覆盖范围，报销比例等方面的差异可能使得农村居民的就医行为有所不同，因此研究多层次医疗保险对农民就医行为的影响有一定的必要性。

本文采用理论研究与实证研究相结合的方法。首先，通过文献梳理明晰相关的概念与理论，再进一步分析多层次医疗保险影响农村居民就医行为的作用机制。最后依据中国家庭追踪调查（CFPS）2014-2020年4期的调查数据，选取就医主动性、就医机构的选择、就医总费用及就医自付费用作为衡量就医行为的指标，利用stata17.0统计软件构建二元Logit模型、多元Logit模型、双向固定效应模型来分别探究多层次医疗保险对农村居民就医行为的影响，并对研究结果进行稳健性检验与异质性分析。

研究表明：多层次医疗保险对促进农村居民就医行为具有积极作用，不同层次保险的作用有所差异。其中基本医疗保险对农村居民主动就医以及到基层医院就医具有显著的促进作用；商业医疗保险显著提升了农村居民到综合医院、专科医院就医的概率；基本医疗保险与商业医疗保险显著降低了农村居民的就医费用自付比例；慢性病对农村居民各项就医行为有显著影响。基于此，本文建议加强农村基层医疗卫生服务体系的建设，强化农村地区商业医疗保险的补充作用，提升农村居民的健康意识与医保认知，在农村地区建立完善的慢性病管理体系。论文旨在推动农村地区医疗卫生事业的发展，提升农村居民生活幸福感，并为多层次医疗保险体系的建设与政策制定提供有益参考。

With the basic establishment and continuous development of China's multi-level medical insurance system, the forms of medical security that citizens can participate in are more abundant. Basic medical insurance, which is the main body of a multi-level medical insurance system, provides basic medical security services for citizens with the characteristics of "wide coverage and basic protection", while commercial medical insurance, which is in a supplementary position, meets the differentiated needs of national medical security with various product types and rich guarantee responsibilities. Through literature research, it is found that medical insurance has a profound impact on the lifestyle of Chinese people. The medical treatment behavior of rural residents has always attracted much attention. Differences in coverage and reimbursement ratio of different levels of medical insurance may lead to differences in the medical treatment behavior of rural residents. Therefore, it is necessary to study the influence of multi-level medical insurance on farmers' medical treatment behavior.

This paper adopts the method of combining theoretical research with empirical research. Firstly, the relevant concepts and theories are clarified through literature review, and then the mechanism of multi-level medical insurance affecting rural residents is further analyzed. Finally, according to the survey data of China Family Tracking Survey (CFPS) from 2014 to 2020, the initiative to seek medical treatment, the choice of medical institution, the total cost of medical treatment and the out-of-pocket cost of medical treatment were selected as indicators to measure medical treatment behavior.stata17.0 statistical software was used to construct binary logit model, multiple logit model and two-way fixed effect model to explore the influence of multi-level medical insurance on rural residents' medical treatment behavior, and the robustness test and regional heterogeneity analysis of the research results were carried out.

The research shows that multi-level medical insurance has a positive effect on promoting the medical treatment behavior of rural residents, and the effect of different levels of insurance is different. Among them, the basic medical insurance plays a significant role in promoting the initiative of rural residents to seek medical treatment and to seek medical treatment in grass-roots hospitals. Commercial medical insurance has significantly increased the probability of rural residents seeking medical treatment in general hospitals and specialized hospitals. Basic medical insurance and commercial medical insurance have significantly reduced the proportion of out-of-pocket payment for medical treatment of rural residents. Chronic diseases have significant influence on various medical treatment behaviors of rural residents. Based on this, this paper proposes to strengthen the construction of rural primary medical and health service system, strengthen the complementary role of commercial medical insurance in rural areas, enhance rural residents' health awareness and medical insurance cognition, and establish a sound chronic disease management system in rural areas. This paper aims to promote the development of medical and health undertakings in rural areas, improve the happiness of life of rural residents, and provide useful reference for the construction of multi-level medical insurance system and policy formulation.