中国医疗保险体系中的自选择与医疗费用——基于灵活就业人员参保行为的研究

Self-selection and Medical Expenditure in Chinese Health Insurance System:Evidence from Informal Employees' Participation

我国社会医疗保险已实现全覆盖,现阶段的主要问题在于医保基金能否实现可持续运行。在现行制度安排下,灵活就业群体参加城镇职工医疗保险可能存在逆选择问题,随着就业形态日趋多样化,这将加剧基金运行的不平衡。本文基于2012-2014年中国家庭追踪调查数据(CFPS),利用中国特有的制度特征,在实证上将逆选择效应同道德风险相区分,验证了选择参加城镇职工医保的人群是医疗费用较高的人群。估计表明,自愿选择参加城镇职工医保的人群医疗支出明显高于强制参保群体,大约高78%;而选择参加城镇职工医保的人群医疗支出比选择参加城乡居民医保高约45%。灵活就业人员参加城镇职工医保提升了他们的福利,但如何规避潜在的基金运行风险,是医保制度设计中不可忽视的问题。

China＇s public health insurance has reached universal coverage. Current challenge is to keep the sustainabitity of health insurance system. According to the arrangement, informal employees can voluntarily participate in the Urban Employee Based Medical Insurance （UEBMI）, which may raise the adverse selection issue. We take advantage of the institutional features of Chinese system, using the China Family Panel Studies （CFPS） 2012- 2014 data, to distinguish adverse selection from moral hazard empirically and find that people who voluntarily participate in UEBMI have higher medical expenditure. The results show that people who voluntarily participate in UEBMI have about 78% more medical expenditure than those who compulsorily participate in UEBMI. Moreover, people who voluntarily participate in UEBMI have about 45% more medical expenses than those who participate in Residents Medical Insurance. The selectable medical insurance will improve the welfare of informal employees. However, it is necessary to reform the health insurance system to avoid the potential risk of deficit of health insurance system.