新农合参保者福利收益的竞争性分配  

Competing Welfare Gain of Enrollees in Chin’s New Rural Cooperative Medical Scheme

作　　者：熊景维[1] XIONG Jingwei

机构地区：[1]华中农业大学农村减贫与发展研究中心,武汉430070

出　　处：《农业技术经济》2022年第10期40-52,共13页Journal of Agrotechnical Economics

基　　金：国家社会科学基金一般项目“农民工市民化的社会成本及其分担机制研究”(编号:21BSH035)。

摘　　要：在医疗保险中,政策参数和保险支付的射幸原则规定着医保待遇分配的救助公平要求和属性。据此,获益参保者间应有比较一致的平均收益率(报销率)。而现实中,新农合参保者的个体收益率存在着较大的人际差异。本文运用浙江、吉林和湖北三地的调查数据,建立和估计参保农民医保收益率影响因素的模型发现,以医保关系资本、信息获取优势和就医行为策略为主要内容的竞争性权能对参保农民的福利收益有显著影响。具体而言,拥有就医—医保关系资源和经常利用该关系资源看病的参保农民,对新农合报销政策了解程度更高或对医保报销程序更熟悉的参保农民,门诊就医经常选择乡镇医院或申请大病救助的农民,获得了平均更高的医保报销率。这预示着新农合参保收益的分配具有以参保者个体权能为承载的福利竞争性质,即其医保福利的实际分配除受正式制度参数和射幸原则的规定性约束外,还在与参保者的互动中受到来自后者的社会和信息资本等个体权能因素、行为策略因应等非正式制度的调节和“修饰”。关注医保收益分配中非正式制度和参保者“竞租”行为的影响,弱化个体和环境因素给医保分配机制附加的额外冲击将有利于制度的公平性和可持续运行。In health insurance,the policy parameters and the shooting-fortunes principle of insurance payments define the requirements for relief equity in the distribution of health insurance benefits.Accordingly,there should be a relatively consistent average rate of return(reimbursement rate) among beneficiary enrollees.In reality,there are large interpersonal differences in the individual rates of return of NRCMS participants.Results of model estimations using survey data from three places in Zhejiang,Jilin and Hubei show that welfare competing powers of enrollees,which emphasize information advantage,social capital,behavior strategies of health seeking and relation resources,have a significant positive effect on their rate of gain from the NRCMS.Specifically,Insured farmers who have medical insurance or treatment related social connection resources and often use the ‘guanxi’ resources to see doctors;or the ones who have a higher understanding of the reimbursement policy of the NRCMS or are more familiar with the reimbursement processes;or who often choose township hospitals for outpatient medical treatment,or apply for medical assistance,have obtained a higher average medical insurance reimbursement rate.This illustrates that although the actual distribution of the NRCMS benefit is generally determined by parameters setting of the formal system as well as the aleatory mechanism of insurance,it is also regulated by factors of an informal system such as enrollees’ social network,information advantages and their adaptive strategic behaviors.The process is just like a welfare competition in which one’s rent-seeking and behavioral tricks,informal institutions and customs of society all play an important role in modifying and decorating the distributing rules of the system.

关 键 词：新农合 福利收益 福利竞争 影响因素 

分 类 号：F842.684[经济管理—保险] F323.89[医药卫生—卫生事业管理] R197.1[医药卫生—公共卫生与预防医学]