医疗保险制度果真“益富”吗——来自中国家庭金融调查的证据  

Does the Medical Insurance System "Benefit the Rich": Evidence from China Household Finance Survey (CHFS)

作　　者：杨融 张永峰 路瑶[1] YANG Rong;ZHANG Yongfeng;LU Yao(School of Economics,Nanjing University,Nanjing 210093,China;Financial Research Institute of the People's Bank of China,Beijing 100000,China)

机构地区：[1]南京大学经济学院,江苏南京210093 [2]中国人民银行金融研究所,北京100000

出　　处：《经济与管理》2023年第5期24-34,共11页Economy and Management

基　　金：国家社会科学基金项目(17BJL081);南京大学优秀博士研究生创新能力提升计划B(202201B003)。

摘　　要：利用2017年中国家庭金融调查(CHFS)数据,在估计医疗保险制度实施前后的基尼系数和泰尔指数的基础上,测算医疗保险制度的政策效果。结果表明,社会医疗保险起到抑制收入差距扩大的再分配作用,商业医疗保险则存在逆向调节的“益富”效应。影响机制在于:低收入群体在社会医疗保险制度中获得的直接报销和间接收入远大于高收入群体,高收入群体在商业医疗保险中的受益程度远高于低收入群体;社会医疗保险有助于缓解低收入家庭的债务陷阱,商业医疗保险可能会扩大低收入家庭的债务危机。进一步研究发现:社会医疗保险有助于改善由健康不平等引起的收入不平等,商业医疗保险更有可能提升高收入群体的医疗服务可及性;社会医疗保险和商业医疗保险对城镇地区居民收入分配的调节作用均大于农村地区。此外,2013年以来社会医疗保险制度的正向再分配效应持续提升;2013—2017年商业医疗保险制度均表现出逆向调节的“益富”效应,2019年未表现出明显的“益富”效应。We estimated the redistribution effect of the medical insurance system and tested the possible impact mechanism based on the data of China Household Finance Survey(CHFS)in 2017.The results show that social medical insurance plays a positive redistribu-tive role in suppressing the widening the income gap,while commercial medical insurance has a reverse regulatory"benefit the rich"effect.The impact mechanism lies in the fact that low-income groups receive far more direct and indirect income in the social medical insurance system than high-income groups,while high-income groups benefit much more from commercial medical insurance than low-income groups;In addition,social medical insurance helps alleviate the debt trap of low-income families,while commercial medi-cal insurance may expand the debt crisis of low-income families.Further research has found that social medical insurance can help im-prove income inequality caused by health inequality,while commercial medical insurance is more likely to enhance the accessibility of medical services for high-income groups;Meanwhile,both social medical insurance and commercial medical insurance have a greater moderating effect on income distribution among urban residents than in rural areas;Finally,the positive redistribution effect of the so-cial medical insurance the system has increased since 2013;The commercial medical insurance system showed a reverse adjustment of the"benefit the rich"effect from 2013 to 2017,but did not show a significant"benefit the rich"nature by 2019.

关 键 词：医疗保险 “亲贫” “益富” 收入分配 

分 类 号：F842.0[经济管理—保险]