我国农村医疗保险体系减贫效应的实现路径及政策效果研究——基于收入再分配实现机制视角  

A Research on the Realization Path and Policy Impact of Poverty Alleviation Effect of China’s Rural Medical Insurance System——Based on the realization mechanism of income redistribution

作　　者：丁少群[1] 苏瑞珍 DING Shao-qun;SU Rui-zhen

机构地区：[1]西南财经大学保险学院

出　　处：《保险研究》2019年第10期114-127,共14页Insurance Studies

基　　金：国家社会科学基金十九大专项“全面建成多层次社会保障体系的实施难点与路径优化研究”(18VSJ095);中央高校基本科研业务费研究项目“我国多层次医疗保障制度的实施难点及创新发展路径研究”(JBK1802027)

摘　　要：医疗保险反贫困既依赖于横向收入再分配实现的"涓滴"效应,也需要发挥纵向收入再分配实现的"亲贫"效应。本文利用山西省2013年和2017年相关数据,运用洛伦兹曲线拟合收入分布的方法,评估了农村医疗保险体系的减贫效应。研究发现:农村医疗保险体系具有"涓滴"减贫效应,但不具有"亲贫"效应,存在对低收入群体的反向调节效应;大病保险及健康扶贫工程的实施并未有效改善低收入群体的收入分布,农村医疗保险体系"损不足补有余"的逆向再分配现象更为严重;农村医疗救助的补偿功能成效初显,但尚未达到改善农村医疗保险收入再分配的规模效应。因此,建议通过提升筹资累进性和推进偿付公平,改善医疗保险纵向收入再分配的"亲贫"效应,从而增强农村医疗保险的减贫效应。同时加大医疗救助对低收入群体的补偿力度,以纠正农村医疗保险的逆向再分配现象。The anti-poverty effect of medical insurance relies on not only the "trickle-down effect" of horizontal income redistribution,but also the "pro-poor effect" of vertical income redistribution.This paper used relevant data of Shanxi Province in 2013 and 2017 to evaluate the impact of poverty alleviation of rural medical insurance system by using the Lorentz curve fitting income distribution method.The study finds that the rural medical insurance system has the trickle-down effect on poverty reduction instead of the "pro-poor effect",and it has a reverse regulation effect on low-income groups;the implementation of supplementary major medial insurance plan and health poverty alleviation project do not improve the income distribution of low-income groups effectively,what’s worse,it has made the phenomenon of reverse redistribution more obvious.The compensation of rural medical aid has begun to pay off,but it has not yet achieved the scale effect to improve the redistribution of rural medical insurance income.Therefore,it is proposed to enhance the "pro-poor effect" of vertical income redistribution of medical insurance by improving progressiveness of financing and promoting fairness of payment,which can strengthen the poverty alleviation effect of the rural medical insurance.At the same time,increasing medical assistance to low-income groups is a way to redress reverse redistribution of rural medical insurance.

关 键 词：农村医疗保险 收入再分配 亲贫 筹资 偿付 医疗救助 

分 类 号：F840.684[经济管理—保险]