灾难性卫生支出风险识别、致贫路径与精准保障研究

This study will attempt to construct a new systemic risk identification framework by combining the expanded Grossman health investment model, econometric techniques of threshold and treatment effects, and complex network analysis and dynamic simulation and forecast method together, and measure and reimburse catastrophic health expenditure in China from the time-series dimension and cross-sectional dimension using the framework. This study aims to extend the existing literature mainly from three aspects. First, we introduce the catastrophic health expenditure budget constraints into the framework of Grossman health investment model, identify the risk-mechanism of catastrophic health expenditure, and explore the catastrophic health expenditure standard of China based on index setting improvement. Second, from the cross-sectional dimension, we test empirically the impoverishing paths of catastrophic health expenditure on income, health and medical expenditure, and assess the impoverishing intensity. In this process, we identify not only the families of catastrophic health expenditure and poverty due to illness, but also the families of quasi- catastrophic health expenditure and quasi- poverty due to illness, and select the targeted objectives and policy instruments according to the types. Third, from the time-series dimension, we analyze the complex short-term promotion and long-term reduction effects of multi- level medical security on catastrophic health expenditure, and evaluate different reimbursement modes’ effects on reducing the medical burden and the incidence of catastrophic health expenditure in order to improve the precision of medical security. This study will improve our understanding of catastrophic health expenditure occurrence and action mechanism, and will provide a guidance for China’s authorities to implement medical security and poverty alleviation policies in the time-series and cross-sectional dimensions.

本课题将Grossman健康投资数理模型拓展、门限效应和处理效应等计量技术、复杂网络分析和动态模拟预测方法三者紧密结合，构建具有特色和创新的灾难性卫生支出风险识别框架，并采用该框架从时空两个维度对我国灾难性卫生支出进行度量和保障。本课题从三个方面拓展现有研究：一是对灾难性卫生支出进行风险识别，在改进完善现有指标设定的基础上，界定中国灾难性卫生支出标准；二是空间维度上，系统分析灾难性卫生支出致贫路径，评估致贫强度，识别已经发生和即将发生灾难性卫生支出和因病致贫家庭，依据类型选择针对性的保障目标和政策工具；三是时间维度上，分解多层次医疗保障对灾难性卫生支出的作用机制，对各种补偿模式下的灾难性卫生支出发生率进行模拟预测和前瞻性度量，提高医疗保障的精准性。本课题预期不仅可以深化学术界和实务界对灾难性卫生支出发生机制和作用机制的认识，还为相关部门在时空两个维度优化我国医疗保障和扶贫政策提供依据指导。

深化研究并精准化解灾难性卫生支出，是完善多层次社会保障体系的必要途径，是贯彻脱贫攻坚战略的关键环节，是实现健康中国的战略举措。本课题构建了具有特色和创新的灾难性卫生支出风险识别框架，并采用该框架从时空两个维度对我国灾难性卫生支出进行度量和保障。本课题主要从三个方面拓展了现有研究：一是将灾难性卫生支出约束条件引入健康投资模型中，对灾难性卫生支出进行风险识别，在改进完善现有指标设定的基础上，界定中国灾难性卫生支出标准；二是空间维度上，系统分析灾难性卫生支出作用收入水平、健康水平和医疗服务利用等因素的致贫路径，评估致贫强度；三是时间维度上，系统分析多层次社会保障体系对灾难性卫生支出的作用效果及其作用机制。. 上述研究不仅深化了学术界和实务界对灾难性卫生支出发生机制和作用机制的认识，还为相关部门在时空两个维度优化我国多层次社会保障制度体系和构建多维贫困长效治理机制提供依据指导。依托本项目，共发表论文15篇，其中CSSCI14篇，SCI1篇,培养硕士毕业生8人。项目部分研究成果获得山东省社会科学优秀成果奖三等奖1项，并获得山东省主要领导批示。

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