因病支出型贫困社会救助政策的减贫效果模拟——基于CFPS数据的分析

Poverty Alleviation and the Effect of Social Assistance Policy on Poverty Caused by Illness:An Analysis of CFPS Data

支出型贫困提供了一种从家庭收入和支出两个维度看待贫困的新型视角。因病支出型贫困是支出型贫困的核心内容,直接影响着扶贫政策的实施效果。论文基于因病致贫研究、支出型贫困研究以及各地因病支出型贫困社会救助政策文件,提出了4种因病支出型贫困的界定方法;并利用2014年中国家庭追踪调查数据,计算了不同界定方法下,中国因病支出型贫困的发生率及其家庭特征。结果发现,在当前主流因病支出型贫困社会救助政策的界定方法下,我国因病支出型贫困发生率和致贫率较高。因病支出型贫困户主要是收入低、自付医疗费用高、存款少、欠债多、家庭资产少且面临较多困难的家庭,需要公共政策的支持。论文模拟测算显示,因病支出型贫困生活救助效果优于医疗救助效果,不设救助起付线的救助效果优于设置救助起付线的救助效果。但是,因病支出型贫困社会救助政策对救助资金需求极高,超出了当前社会救助制度的筹资能力。论文建议,因病支出型贫困社会救助政策应定位于保大病,以医疗救助为主体,并设置一定的起付线;应以基本医疗保险制度为主体化解因病支出型贫困风险,应多渠道筹集资金;应提高低保制度瞄准效率以更高效、公平地利用社会救助资金化解因病支出型贫困风险。

Expenditure poverty provides a new perspective to look at poverty from two dimensions: family income and expenditure. As a core element of expenditure poverty,the poverty caused by illness directly affects China' s poverty alleviation policy. Using research on illness poverty,expenditure poverty and social assistance policy documents,this study defined four types of poverty caused by illness. Using data from the 2014 China Family Panel Studies,this paper calculated the incidence of poverty caused by illness and family characteristics using different definitions. According to the mainstream definition of poverty,China ' s incidence of poverty caused by illness was very high.The families experiencing poverty because of illness had lower income,higher medical expenses,less money on deposit,more debts,less family assets and more difficulties,and therefore needed more public policy support. The results of the simulation calculation show the effect of poverty alleviation on life assistance was better than medical assistance,and the poverty alleviation effect of a lower insurance deductible was even better. However,the demand for the assistance funds was very high and beyond the means of the then-current social assistance system. Accordingly, this paper suggests that social assistance policy should focus on serious illnesses,rely on medical assistance rather than life assistance, and set a reasonable amount for insurance deductibles. Furthermore, the basic medical insurance system should remain the primary means to alleviate poverty caused by illness. To that end,the social security system should collect more funds; and,the minimum living security system should target more efficient and equitable means to alleviate poverty caused by illness.