健康公平视角下的城乡居民医疗支出不平等研究——基于生命周期模型  

Inequality in Medical Expenditure between Urban Employees and Rural Indivi-duals from a Health Equity Perspective:Based on a Life-cycle Model

作　　者：廖朴[1,2] 刘金浩 冯璐 LIAO Pu;LIU Jinhao;FENG Lu(China Institute of Actuarial Science,Central University of Finance and Economics,Beijing 102206,China;School of Insurance,Central University of Finance and Economics,Beijing 102206,China;School of Economics and Management,Beijing University of Posts and Telecommunications,Beijing 100086,China)

机构地区：[1]中央财经大学中国精算研究院,北京102206 [2]中央财经大学保险学院,北京102206 [3]北京邮电大学经济管理学院,北京100086

出　　处：《当代经济科学》2024年第2期1-16,共16页Modern Economic Science

基　　金：高等学校学科创新引智计划资助项目“保险风险分析与决策学科创新引智基地”(B17050);国家自然科学基金青年项目“数据资本垄断视角下平台经济的要素收入分配效应及福利分析”(72103025);教育部人文社会科学研究一般项目“平台经济、数据垄断与我国收入分配不平等:理论机制、实证检验与对策研究”(21YJC790026)。

摘　　要：促进健康公平是中国医疗体制改革的重要目标之一。建立居民医疗支出内生决策的生命周期模型,根据实际数据采用模拟矩估计法估计城乡居民偏好参数,通过模型求解揭示居民的医疗支出行为特征及城乡差异,并讨论相关政策对城乡医疗支出不平等的影响。研究表明:城乡居民的生命周期最优医疗支出均呈现倒U型,但医疗支出水平具有明显差异;收入差距、主观偏好差异和基本医疗保险制度差异是造成该现象的重要原因且重要性依次降低;增加农村居民收入、提高农村居民医疗保险保障水平、提升医疗技术以及引入普惠型健康保险可以有效缩小城乡居民医疗支出差距。因此,应增强城乡居民医疗保险制度的福利性,积极在农村地区推广惠民保等普惠型健康保险,进一步增加农村居民收入,以缩小城乡医疗支出差距。Promoting health equity stands as a fundamental objective within China’s medical system reform efforts.Through policy introduction and reform deepening,significant strides have been made in enhancing health equity.Nonetheless,due to China’s typical urban-rural dual economic structure,a noticeable health gap persists between urban and rural regions.Despite prevailing literature predominantly grounded in econometric methodology,focusing on health inequality,it fails to unveil individuals’medical expenditure decision-making processes and inherent mechanisms.This study establishes a framework for optimal consumption,savings,and medical expenditure decision-making based on lifetime expected utility maximization.Herein,medical expenditure and natural laws jointly dictate disease recovery and mortality rates.Parameters for income and basic medical insurance systems for urban and rural individuals are calibrated,with medical expenditure estimations derived via the Simulated Method of Moments for structural estimation of urban and rural individual characteristics.Leveraging the calibrated parameters and framework,this paper addresses medical expenditure decisions for urban and rural individuals,disentangles reasons behind expenditure disparities,and simulates policy counterfactuals to mitigate urban-rural medical expenditure gaps.Findings indicate that optimal savings and medical expenditures across the life cycle exhibit a distinct inverted U-shape for urban and rural individuals.Notably,the turning point for optimal savings and medical expenditures among urban workers occurs pre-retirement,contrasting with rural individuals at age 80.The significant medical expenditure gap between urban and rural cohorts is attributed to income differentials,subjective preference variations,and disparities in basic medical insurance systems,albeit with diminishing importance.Moreover,improving rural income,augmenting medical insurance coverage,technological advancements in healthcare,and universal health insurance introduction eme

关 键 词：健康公平 医疗支出 健康选择 城乡差异 生命周期模型 模拟矩估计 

分 类 号：F126.1[经济管理—世界经济] R197.1[医药卫生—卫生事业管理]