目的：探讨实施均等化的基本医疗保险制度能否缩小不同收入群体间的健康差距。方法：本文基于2016年-2020年中国家庭追踪调查（CFPS）数据、各类统计年鉴以及相关政策文件,以职工基本医疗保险省级统筹为视角,采用三重差分法（DDD）考察均等化基本医疗保险政策对不同收入群体间健康差异的影响。结果：（1）相比中高收入群体,省级统筹后低收入群体患慢性病概率显著下降约6.80%,表明省级统筹政策缓解了收入差距所带来的健康不平等状况;（2）低收入群体主要通过提高就医概率和身体锻炼频率改善自身健康状况,医疗费用支出对改善低收入群体健康状况方面的作用并不显著;（3）省级统筹后,退休职工对自身健康状况的评价更高。结论：建议逐步推进基本医保省级统筹,推动医疗卫生服务均等化,加强对弱势群体的保障力度,提高全民健康素养,促进社会公平。
Abstract
Objective: The paper attempts to explore whether the implementation of a parity health insurance system can reduce the health disparity between different income groups. Methods: Based on the CFPS data from 2016 to 2020 , various statistical yearbooks and relevant policy documents, this paper examines the impact of equalized basic health insurance policies on health inequality among different income groups using DDD model through the lens of the provincial coordination of urban employees’ basic health insurance. Results: (1) Compared with the middle and high income groups, the probability of chronic diseases in the low income group decreased significantly by about 6.80% after the coordination policy, indicating that the provincial coordination policy alleviated the health inequality; (2) The low income group mainly improved their health status by increasing the probability of medical treatment and the frequency of physical exercise and the effect of medical expenditure on improving the health status of low income groups is not significant; (3) After the provincial coordination, retired employees have a higher evaluation of their own health status. Conclusion: It is recommended to gradually promote the provincial coordination of medical insurance and the equalization of healthcare services, strengthen the guarantee of disadvantaged groups, improve the national health literacy, and promote social equity.
关键词
医疗改革 /
健康公平 /
社会经济地位 /
医疗服务利用
Key words
health care reform /
health equity /
socioeconomic status /
health service utilization
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参考文献
[1] Brinda E M, Attermann J, Gerdtham U G, et al.Socio-economic inequalities in health and health service use among older adults in India: results from the WHO Study on Global AGEing and adult health survey[J]. Public Health, 2016, 141: 32-41.
[2] 朱恒鹏,岳阳,林振翮.统筹层次提高如何影响社保基金收支——委托—代理视角下的经验证据[J].经济研究,2020,55(11):101-120.
[3] 郑功成. 从地区分割到全国统筹——中国职工基本养老保险制度深化改革的必由之路[J]. 中国人民大学学报, 2015, 3: 2-11.
[4] 封进,王贞.延迟退休年龄对城镇职工医保基金平衡的影响——基于政策模拟的研究[J].社会保障评论,2019,3(02):109-121.
[5] Fuchs V R.The future of health economics[J]. Journal of Health Economics, 2000, 19(2): 141-157.
[6] Lindahl M.Estimating the effect of income on health and mortality using lottery prizes as an exogenous source of variation in income[J]. Journal of Human resources, 2005, 40(1): 144-168.
[7] 解垩. 与收入相关的健康及医疗服务利用不平等研究[J]. 经济研究, 2009, 2(2): 93-105.
[8] Allin S, Masseria C, Mossialos E.Equity in health care use among older people in the UK: an analysis of panel data[J]. Applied Economics, 2011, 43(18): 2229-2239.
[9] 马超,顾海,孙徐辉. 参合更高档次的医疗保险能促进健康吗?——来自城乡医保统筹自然实验的证据[J]. 公共管理学报, 2015 (2): 106-118 157-15.
[10] 何文,申曙光.城乡居民医保一体化政策缓解了健康不平等吗?——来自中国地级市准自然实验的经验证据[J].中国农村观察,2021(03):67-85.
[11] 周钦,田森,潘杰.均等下的不公——城镇居民基本医疗保险受益公平性的理论与实证研究[J].经济研究,2016,51(06):172-185.
[12] Bindman A B, Grumbach K, Osmond D, et al.Preventable hospitalizations and access to health care[J]. Jama, 1995, 274(4): 305-311.
[13] Finkelstein A, Taubman S, Wright B, et al.The Oregon health insurance experiment: evidence from the first year[J]. The Quarterly journal of economics, 2012, 127(3): 1057-1106.
[14] 洪岩璧,曾迪洋,沈纪.自选择还是情境分层?——一项健康不平等的准实验研究[J].社会学研究,2022,37(02):92-113+228.
[15] Cockerham W C.Medical sociology[M]. Routledge, 2017.
[16] 石智雷,顾嘉欣,傅强.社会变迁与健康不平等——对第五次疾病转型的年龄—时期—队列分析[J].社会学研究,2020,35(06):160-185+245.
[17] De Chaisemartin C, d'Haultfoeuille X. Two-way fixed effects estimators with heterogeneous treatment effects[J]. American Economic Review, 2020, 110(9): 2964-96.
基金
国家社科基金后期项目“中国养老保险制度中的退休激励问题研究”（21FGLB073）
