社会医疗保险缓解了未成年人健康不平等吗  

Does Health Insurance Relive Health Inequality among Children

作　　者：彭晓博 王天宇 

机构地区：[1]中央财经大学经济学院 [2]中国人民大学劳动人事学院

出　　处：《中国工业经济》2017年第12期59-77,共19页China Industrial Economics

基　　金：教育部人文社会科学基金青年基金项目"出生体重;健康与认知能力"(批准号17YJC790116);国家社会科学基金重大项目"建立社会公平保障体系与维护社会公平正义研究"(批准号13&ZD042);国家自然科学基金青年项目"全面二孩政策对女性就业的影响:计量证据;理论建模与对策模拟"(批准号71703006)

摘　　要：本文使用中国健康与营养调查数据,考察了新型农村合作医疗对中国农村未成年人健康不平等的影响。利用健康集中指数度量不平等程度所进行的实证分析和集中指数分解结果表明,虽然新农合的实施改善了农村地区未成年人的整体健康状况,但不同收入家庭中未成年人群体间的健康差距不断扩大,其中新农合的作用不可小觑,而且其贡献程度随时间推移不断增加。针对医疗服务利用不平等的计量分析证实,收入最高的1/4人群使用预防医疗服务的概率比收入最低1/4人群高出40%,其中新农合的贡献约占18%。针对报销比例和封顶线对医疗服务利用不平等影响的理论分析和数值模拟结果表明,医疗服务消费增量随财富增加而增加,财富效应被新农合扩大。本文的研究结论证实了新农合加剧未成年人健康不平等现象的客观存在性,这与医疗保险增进公平的价值取向相悖。建议进一步完善新农合制度设计,防止其在健康状况普遍改善的情况下成为弱势群体相对健康状况恶化的重要诱因。Armed with the longitudinal data from China Health and Nutrition Survey （CHNS）, this paper examines the causal relationship between the roll-out of the New Rural Cooperative Medical Scheme （NCMS） and the health inequality among children in rural China. Although health status of the covered children were improved, the NCMS is still a source of the rise of health inequality measured by Concentration Indices among children, and its contribution increased as time goes by. Evidence about the inequity in health service delivery finds that the richest 1/4 utilizes 40% more preventive health care than the poorest did, and for which the NCMS contributes about 18%. Theoretical analysis and simulation shows that increment of health care consumption increases with wealth, indicating that the wealth effect is magnified by the NCMS. Our research provides some evidence about the NCMS increases the gap among children＇s health, indicating the importance of the NCMS improvement, so as to prevent it from enlarging health inequality among people of different income.

关 键 词：健康不平等 新型农村合作医疗 集中指数分解 

分 类 号：F126[经济管理—世界经济]