目的: 以城乡居民医保整合为契机,分析城乡医保整合对农村居民灾难性医疗支出的影响,以评估城乡医保整合的政策效应。方法: 本文使用中国家庭追踪调查数据 （CFPS）2016年、2018年、2020年三期数据,采用多期双重差分模型,实证评估城乡居民医保整合对农村居民灾难性医疗支出的影响。结果: 城乡居民医保整合后,农村居民灾难性医疗支出发生率降低9%;基于年龄分组,18—34岁年龄组灾难性医疗支出发生率降低0.16%,但55岁及以上老年人群灾难性医疗支出发生率提高3%,对35—54岁中年人群影响不显著;基于收入分组,城乡居民医保整合后,中低收入家庭灾难性医疗支出发生率降低7.4%,但对于高收入家庭影响不显著。结论: 城乡居民医保整合降低了农村居民灾难性医疗支出发生率,对缩小城乡居民医疗保障水平差距有促进作用,对中低收入人群政策实施达到预期效果,但对于老年人医疗支出风险应进一步关注,后续应向老年人群实施倾斜性补偿政策。

Objective: Taking the integration of urban and rural residents' medical insurance as an opportunity, the paper analyzes the impact of urban and rural medical insurance integration on catastrophic medical expenses of rural residents, and evaluates the effects of urban and rural medical insurance integration policy. Methods: This article uses China Family Panel Survey (CFPS) data from 2016, 2018, and 2020, and adopts a multi-period DID model to empirically evaluate the impact of urban and rural resident medical insurance integration on catastrophic medical expenditures of rural residents. Results: The integration of medical insurance for urban and rural residents reduced the incidence of catastrophic medical expenses for rural residents by 9%. Based on age groups, the integration of medical insurance for urban and rural residents reduced the incidence of catastrophic medical expenses by 0.16% in the groups aged 18~34, but increased the incidence of catastrophic medical expenses by 3% in the elderly population aged 55 and above, with no significant impact on the middle-aged population aged 35~54. Based on income groups, the integration of medical insurance for urban and rural residents reduced the incidence of catastrophic medical expenses for low and middle-income families by 7.4%, but the impact on high-income families was not significant. Conclusion: The integration of medical insurance for urban and rural residents has reduced the incidence of catastrophic medical expenses for rural residents, promoted the narrowing of the gap in healthcare security levels between urban and rural residents, and achieved the expected effect for low and middle-income groups. However, further attention should be paid to the risk of medical expenses for the elderly, and compensation policies should be implemented for the elderly in the future.