摘要
改善医保再分配功能对促进全民医保高质量发展和扎实推进共同富裕有重要意义。采用中国家庭追踪调查(CFPS)2014年、2016年和2018年三期平衡面板数据,分析全民医保的再分配效应及其动态变化,结果发现,医疗支出具有负向再分配效应,且尽管医保报销具有正向再分配功能,但不足以逆转医疗支出再分配效应的方向。不同医保制度的再分配功能存在程度差异,医保报销环节中公费医疗最强,职工医保居中,居民医保最弱,这与医保制度间的发展不均衡有关。在三个调查年份,三种医保制度报销的再分配效应均先增后减,但农村参保者医疗自付的再分配效应在医保城乡一体化后并未减弱。不利于低收入者的健康不平等与不高的医保报销水平阻碍了医保正向再分配功能的发挥。实施全民准公费医疗,强化对低收入者的医疗救助,并积极发挥慈善的作用,是提升医保再分配功能的有效治理策略。
Improving the redistributive effects of medical insurance is of great significance in solidly promoting the high-quality development of universal medical insurance and the pursuing of common prosperity in China.Based on a three-wave balanced panel data of the China Family Panel Survey(CFPS)conducted in 2014,2016 and 2018,this paper analyzes the redistributive effects of universal health insurance and its dynamic changes.It is found that medical expenditure has a negative redistributive effect,and although medical insurance reimbursement performs a positive redistributive function,it is not enough to reverse the direction of medical expenditure's redistributive effect.The redistributive function of different medical insurance schemes is different in degree.As far as the reimbursement link is concerned,free medical service system's positive redistributive function is the strongest,medical insurance system for urban employees is in the middle,and the medical insurance system for residents is the weakest,which indicates an unbalanced development of medical insurance schemes.In the three survey years,the redistributive effect of the reimbursement of the three medical insurance schemes increased first and then decreased,but the redistributive effect of the medical out-of-pocket payment of rural participants did not weaken after the urban-rural integration of residents'medical insurance.Health inequalities that disadvantage low-income people and low level of medical insurance reimbursement hinder the positive redistributive function of medical insurance.Implementing quasi free medical service system,strengthening medical aid for low-income people,and actively playing the role of charities are effective governance strategies to enhance the redistribution function of medical insurance.
出处
《社会保障研究》
CSSCI
北大核心
2023年第3期3-17,共15页
Social Security Studies
基金
教育部哲学社会科学研究重大课题攻关项目“促进困难群体共同富裕的社会政策体系建设研究”(22JZD025)
“全面建设社会主义现代化国家新征程中加快实现共同富裕研究”(批准号:21JZD019)的阶段性成果
中央高校基本科研业务费资助
浙江省哲学社会科学重点研究基地浙江大学民生保障与公共治理研究中心自设课题“共同富裕的社会政策之维:保护主义与发展主义的平衡与融合”(23JDZSZD01)成果
关键词
医疗保险
再分配效应
纵向公平
医疗救助
共同富裕
medical insurance
redistributive effects
vertical equity
medical aid
common prosperity
