灵活就业人员医疗保险参与及受益归属——基于逆向选择和正向分配效应的双重检验  

Participation Behavior and Benefit Attribution of Medical Insurance for Informal Employees—Double Test Based on Adverse Selection and Positive Distribution Effect

作　　者：何文 申曙光[1] HE Wen;SHEN Shuguang(Sun Yat-sen University,510275)

机构地区：[1]中山大学岭南学院,510275

出　　处：《财贸经济》2020年第3期36-48,共13页Finance & Trade Economics

基　　金：国家社会科学基金重大项目“预防为主的大健康格局与健康中国建设研究”(17ZDA080)。

摘　　要：当前,灵活就业人员医疗保险发展不充分与不平衡的问题格外突出,这不仅会制约医保制度公平性与可持续能力的提高,同时会阻碍经济社会的全面、协调和可持续发展。本文运用中国劳动力动态调查数据(CLDS),研究灵活就业人员参加医保的决定因素以及受益归属,从而为新时期医保制度顶层设计提供决策依据。结果表明:一方面,无论是在参保决策还是险种决策阶段,灵活就业人员的健康风险显著正向影响参保状态,说明逆向选择效应显著存在;另一方面,低收入的参保人利用了更多优质的医疗服务,获得了更多的医保基金补偿,并显著改善了健康状况,因此医保发挥了积极的正向分配作用。但是过高的保障水平,在改善医疗可及性的同时会激发道德风险,从而加剧逆向选择问题并阻碍正向分配效应,对更加公平可持续医保制度的建立造成负面影响。At present,there is an inadequate and unbalanced development of medical insurance for informal employees.It will not only restrict the fairness and sustainability of the medical insurance system,but also hinder the comprehensive,coordinated and sustainable development of the economy and society.This paper uses the China Labor Dynamics Survey Data(CLDS)to study the determinants for informal employees to purchase the medical insurance and their benefit attribution.The results show that:On the one hand,when informal employees debate over to buy the medical insurance or not or which medical insurance policy to buy,their health risk has significant positive impact on their insurance decision,which indicates that the adverse selection effect is significant.On the other hand,low-income insured people have received better medical services and compensation from the medical insurance fund,and their health status has been significantly improved,so medical insurance has played a positive distribution role.However,the change in the insurance status and the improvement of reimbursement level will cause moral hazard while improving the accessibility of medical care,which will aggravate the problem of adverse selection,hinder the positive distribution effect,and have a negative impact on the establishment of a more equitable and sustainable health insurance system.

关 键 词：灵活就业人员 医疗保险 健康 逆向选择效应 正向分配效应 

分 类 号：F062.6[经济管理—政治经济学]