逆向选择还是制度“漏洞”:全民医保下的不连续参保行为研究  

Adverse Selection or Institution Flaw:Research on the Unstable Insurance Participant under the Universal Health Insurance

作　　者：王昭茜 仇雨临[1,2] Wang Zhaoxi;Qiu Yulin

机构地区：[1]中国人民大学劳动人事学院 [2]中国人民大学中国社会保障研究中心

出　　处：《兰州学刊》2021年第6期124-138,共15页

基　　金：中国人民大学科学研究基金(中央高校基本科研业务费专项资金资助)项目成果(项目编号:20XNH058)。

摘　　要：虽然我国已实现基本医疗保险全民覆盖,但实践中有部分群体选择从基本医保制度中退出,全民医保覆盖具有其不稳定性。文章运用中国家庭追踪调查(CFPS)的数据分析在全民医保下部分群体参保中断的现象,并从逆向选择与制度设计可能的“漏洞”两方面探讨影响参保中断的因素。研究发现约有5%的参保者选择从原有的保障制度中退出,逆向选择和制度性因素均能部分解释这一行为,但自愿性的参保原则、待遇水平与个人负担、组织管理效率等制度设计因素,对个人不连续参保行为的解释力更强。因此,需要优化基本医保的制度设计、激励机制与治理结构,实现从基本医疗保险全民覆盖到全民稳定覆盖。Although China has achieved national health insurance universal coverage,some people choose to quit from basic health insurance,and this means that universal coverage of health insurance is unstable.This paper uses the data from China Family Panel Studies to observe the unstable insurance participant under universal coverage,and analyze the influencing factors on participant quit from the perspective of adverse selectionand institution factors.The study finds that there are about 5 percent of participants who choose to quit from the former insurance they joined,and adverse selection and institution factors can all partly explain this behavior.However,some institution factors such as voluntary insured principles,treatment levels and personal burdens,and organizational management efficiency have more significant influence on people’s unstable participant.Due to this result,the government should optimize the system design,incentive mechanism and governance structure of basic medical insurance in order to achieve the basic health insurance from universal coverage to universal stable coverage.

关 键 词：全民医保 不连续参保 逆向选择 医疗保险制度“漏洞” 

分 类 号：C913.7[经济管理]