职工医保缓解相对贫困脆弱性的效应与路径  

The Effect and Approach of Employee Medical Insurance to Alleviate Vulnerability to Relative Poverty

作　　者：张广科[1] 郑子媛 ZHANG Guangke;ZHENG Ziyuan(School of Public Administration,Zhongnan University of Economics and Law,Wuhan 430073,China)

机构地区：[1]中南财经政法大学公共管理学院,湖北武汉430073

出　　处：《中南财经政法大学学报》2023年第4期53-69,共17页Journal of Zhongnan University of Economics and Law

基　　金：国家社会科学基金项目“后小康时代农户相对健康贫困的演变逻辑及其长效治理机制研究”(20BZZ044)。

摘　　要：我国居民医保需求持续扩大但医保待遇不均问题日益突出,这一现象持续发展可能加剧收入不平等和因病致贫产生新的不平等。本文使用CFPS2018数据实证检验职工医保相比于居民医保在缓解因病致贫风险中的作用,研究发现户主参加职工医保能有效减缓由健康风险冲击引致的相对贫困脆弱性,且该减缓效应对于慢性病风险的效果最大,住院风险次之,健康恶化风险最弱。异质性分析表明,职工医保对因病致贫的影响存在居住地异质性、户主年龄异质性和家庭受教育程度异质性。机制分析表明,职工医保可以降低家庭就业率、平均劳动时间和增加患者外出工作概率的分工调整;增加家庭公共转移支付、替代私人转移支付和增加人均纯收入的收入保障,以及增加家庭生存型消费、发展型消费和享受型消费的消费平滑,这些效应发挥了降低相对贫困脆弱性的作用。因此,建议逐步缩小职工医保与居民医保待遇差距,改善医保受益不均的结构性矛盾,将医疗保险对家庭低效风险应对策略的替代作用纳入医疗保险最优保障水平的考量之中。The demand of medical insurance in China has continued to expand,but the uneven levels of medical insurance treatment are prominent,which exacerbates income inequality and create new inequality due to poverty caused by illness.Based on CFPS2018,this paper examines the impact of employee medical insurance on alleviating the risk of poverty due to illness compared with the role of basic medical insurance for residents.The results show that employee medical insurance effectively reduces the vulnerability to relative poverty caused by health risks.The impact is the largest in the risk of chronic diseases,followed by risks of hospitals and health deterioration.Heterogeneous analysis shows that the impact of employee medical insurance on poverty reduction due to illness varies according to the residence,the age of the head of household,and the degree of family education.The mechanism analysis shows that the employee medical insurance reduces the employment rate and the average labor time and increases the probability of patient′s being out-of-work through the division of labor adjustment mechanism.The employee medical insurance increases the public transfer payment,replaces private transfer payment,and increases per capita income through the income security mechanism.Moreover,the employee medical insurance increases the family′s survival consumption,development consumption,and enjoyment consumption through the consumption smoothing mechanism,which all plays a role in reducing vulnerability to relative poverty.Therefore,we recommend gradually reducing the gap between employee medical insurance and basic medical insurance for residents,and eradicating the structural contradictions of uneven benefits of medical insurance,in addition to considerate the substitution of medical insurance for family′s inefficient strategies to deal with risk when we analyze the optimal level of medical insurance.

关 键 词：健康风险冲击 职工基本医疗保险 居民基本医疗保险 相对贫困脆弱性 因病致贫 

分 类 号：F842.6[经济管理—保险]