中国农村医疗保障制度:一项基于异质性个体决策行为的理论研究

Health Care System in Rural China: A Quantitative Approach Based on Heterogeneous Individuals

2003年初新型农村医疗保障制度在全国范围内试点。本文研究以下三个问题：这个自愿型的医疗保障体系的参与率有多高？保障体系自身是否可能实现收支平衡？人头税形式的缴费方式是否会使穷人受损而富人获利？为此，我们构建了一个异质性个体的消费一医疗支出决策模型，在拟合农村消费一医疗支出行为的基础上计算了农村医疗保障制度的福利效应。结果表明，在一定条件下，现行制度可以实现收支平衡，参与率可以在90％以上，健康状态较差的穷人是最大的受益者。

This paper aims at providing some responses to the following three hotly debated issues regarding China＇s new rural cooperative medical system （CMS）, which was launched at the beginning of 2003. Firstly, how many people would join the system voluntarily？ Secondly, can the system be self-balanced？ And thirdly, would the lump-sum tax benefit the rich more than the poor？ We build a decision model with heterogeneous agents and compute the implications of the CMS and find under certain conditions, the system can be self-financed and sustained and the rate of participation could be higher than 90%. Moreover, it is the unhealthy poorer that benefit more from the CMS.