城乡医保整合对农业流动人口医疗服务利用的影响路径及政策优化研究  

The Influence Mechanism and Policy Optimization of Urban-Rural Medical Insurance Integration on the Utilization of Medical Services by Agricultural Migrants

作　　者：上官霜月 郑晓冬 方向明[1] ShangGuan Shuangyue;Zheng Xiaodong;Fang Xiangming

机构地区：[1]中国农业大学全球食物经济与政策研究院 [2]浙江工商大学经济学院

出　　处：《兰州学刊》2024年第8期146-160,共15页

基　　金：国家社会科学基金重点项目(项目编号:21AJL015);清华农村研究博士论文奖学金项目(项目编号:202017)。

摘　　要：城乡医保整合一方面消除了城乡户籍居民医保待遇差异,另一方面提高了流动人口的医保便携性,缓解了农业流动人口医疗保障的双重弱势。文章基于2018年中国流动人口动态监测调查(CMDS)数据,多维度细化拆解城乡医保整合的政策效果,并探究潜在的政策盲区及改进。研究表明:(1)城乡医保整合显著提高了农业流动人口的医保待遇和适用性,从而实现释放更多医疗服务需求的同时降低医疗负担;(2)相比于医保待遇的改善,整合后对参保地限制的放宽,在释放农业流动人口医疗需求中发挥着更显著的作用;(3)城乡医保整合缓解了新农合时期医保制度的亲富人式不平等;(4)虽然城乡医保整合能够提升农业流动人口医保适用性,但提升幅度显著低于城市户籍流动人口;提高农业人口的政策认知水平有助于缩小这一差异;(5)城乡医保整合可能会增加农业流动人口的过度医疗倾向,丰富他们的医疗健康知识,提高对疾病的认知,有助于缓解过度医疗问题。文章的主要贡献在于:同时考虑了医疗服务利用的物质成本和时间成本,区分不同医保类型和参保地,加深了对城乡医保整合福利效应的细化理解;并从城乡获益差异和过度医疗倾向入手,发现了政策宣传和医疗健康知识普及对提高医保政策效率、优化政策获益结构的重要作用。The urban-rural medical insurance integration serves to eliminate the disparity in medical insurance benefits between urban and rural residents,while also enhancing the portability of medical insurance for the floating population,thus alleviating the dual vulnerability of medical security for agricultural migrants.Drawing on data from the 2018 China Migrant Dynamic Survey(CMDS),this article delves into the multifaceted policy effects of integrating urban and rural medical insurance and explores potential blind spots and avenues for improvement.Research findings suggest that:(1)Integration significantly enhances medical insurance benefits and applicability for agricultural migrants,thereby addressing more medical service demands while reducing the burden of medical expenses.(2)Beyond improvements in medical insurance benefits,post-integration relaxation of restrictions on insured areas notably facilitates meeting the medical needs of agricultural migrants.(3)Urban-rural medical insurance integration mitigates the pro rich inequality inherent in the medical insurance system during the New Rural Cooperative Medical Scheme era.(4)While integration improves medical insurance applicability for agricultural migrants,the extent of enhancement is notably lower compared to urban migrants;raising policy awareness among agricultural populations helps narrow this gap.(5)Integration may exacerbate agricultural migrants’inclination towards excessive medical treatment;enriching their medical health knowledge and disease awareness can help mitigate this issue.The article contributes by simultaneously considering material and time costs of medical service utilization,distinguishing between various medical insurance types and insured areas,thereby deepening our nuanced understanding of the welfare effects of integrating urban and rural medical insurance.By addressing urban rural benefit disparities and tendencies towards excessive medical treatment,it underscores the vital role of policy advocacy and dissemination of medical heal

关 键 词：城乡医保整合 农业流动人口 医疗服务利用 过度医疗 

分 类 号：F323[经济管理—产业经济]