我国儿童社会医疗保险参与和报销情况分析与思考——基于中国家庭追踪调查CFPS数据

An Analysis and Reflection on the Participation and Reimbursement of Children's Social Medical Insurance in China: Based on the Data of China Family Panel Studies

在全民医疗保障体系的建设中,儿童是值得关注的群体。基于中国家庭追踪调查(CFPS)2010、2012和2014年的数据分析我国城乡儿童社会医疗保险实际参与情况与医疗支出实际报销情况。结果表明:(1)全国儿童总体参保率不到70%,没有表现出明显的时间趋势和城乡差异。(2)动态视角下,三轮调查中一直参保的儿童占比为27.1%,超过30%的儿童参保后退保。(3)对特殊群体的考察发现,无户口儿童、城镇流动儿童和学龄前儿童参保率更低。(4)从报销比例来看,儿童社会医疗保险对住院儿童报销比例约为10%,对普通门诊的报销比例更低。

In the construction of the universal health care system, a group of people that worthy of attention is the group of children. Based on the data of China Family Panel Studies（CFPS） of 2010, 2012 and 2014, this paper analyzes the actual participation of children＇s social medical insurance and the actual reimbursement for their medical expenses. The results show that：（1） Children＇s overall participation rate is less than 70%, and no sign shows any obvious time trend or urban-rural differences.（2） From a dynamic perspective, it is found from the three rounds of investigates that only 27.1% of the children are constantly insured, over 30% of the children cancelled after taking part in the insurance.（3） An investigation of some special groups of children finds that the participation rates of the children without permanent registered residence, the migrant children from rural to urban areas and the preschool children are much lower.（4） From the view of the reimbursement ratio, the current children＇s social health insurance only reimburses the enrolled children for only 10% of their hospitalization expenditures, while the rate is even lower for ordinary outpatient services.