社会医疗保险介入与家庭代际经济交换:影响效应与作用机制  

Effect and Mechanism of Social Medical Insurance Intervention on the Intergenerational Economic Exchange in Family

作　　者：于大川[1] 丁建定[2] 田向东[1] YU Dachuan;DING Jianding;TIAN Xiangdong

机构地区：[1]广东金融学院社会保障研究所,广东广州510521 [2]华中科技大学社会学院,湖北武汉430074

出　　处：《社会保障研究》2020年第5期39-50,共12页Social Security Studies

基　　金：教育部人文社科青年基金项目“农村医疗保障制度的健康扶贫效应及提升策略研究”(编号:19YJC840055);广东省哲学社会科学“十二五”规划学科共建项目“社会支持网络视角下广东省空巢老人健康促进机制研究”(编号:GD15XSH03)成果。

摘　　要：文章利用2014年中国老年健康影响因素跟踪调查(CLHLS)数据,使用OLS模型和PSM方法实证分析社会医疗保险介入对家庭代际经济交换的影响,并运用Bootstrap中介效应检验法对两者之间的作用路径进行检验。结果发现:医疗保险介入促进了家庭代际的经济交换,表现为向上的代际经济供养明显减少,而向下的代际经济资助明显增加;医疗保险对家庭代际经济交换的影响存在城乡和年龄差异,医疗保险对城镇、高龄老年人的代际经济供养有负向影响,对农村、低龄老年人的代际经济资助有正向影响;老年人经济和健康状况改善是医疗保险影响家庭代际经济交换的两条主要路径,在“医疗保险—代际经济供养”中发挥了完全中介作用,在“医疗保险—代际经济资助”中发挥了部分中介作用。文章建议,要从保障能力、公平性、弱势群体倾向性、多层次性等方面对社会医疗保险制度进行系统改革。Based on CLHLS 2014 data,this paper uses OLS model and PSM method to analyze the influence of medical insurance intervention on intergenerational economic exchange in family,and uses Bootstrap mediation effect test method to test the influence path.The results show as follow:the intervention of medical insurance promotes the intergenerational economic exchange in family,which is reflected in the obvious decrease of the upward intergenerational economic support and the obvious increase of the downward intergenerational economic support;the influence of medical insurance on the intergenerational economic exchange in family is different between urban and rural areas and among different ages,which has negative influence on the upward intergenerational economic support of the urban elderly and the advanced elderly,and has positive influence on the downward intergenerational economic support of the rural elderly and the young elderly;the economic and health status improvement of the elderly is the two main ways for medical insurance to influence the intergenerational economic exchange in family,which plays a full intermediary role in"medical insurance-upward intergenerational economic support"and a partial intermediary role in"medical insurance-downward intergenerational economic support".The paper suggests that the social medical insurance system should be reformed systematically from the aspects of guarantee ability,fairness,tendency of vulnerable groups and multi-levels.

关 键 词：社会医疗保险 家庭代际经济交换 挤出效应 挤入效应 中介效应 

分 类 号：C91[经济管理]