社会医疗保险减贫效应的异质性检验--基于2010-2017年31个省份面板数据的经验考察

A Heterogeneous Test on the Poverty Alleviation Effectiveness of Social Health Insurance--An Empirical Examination Based on the Panel Data of 31 Provinces from 2010 to 2017

社会医疗保险能够减轻参保群体医疗负担,是防止因病致贫和因病返贫的重要手段。采用DANP方法可确定影响社会医保减贫效果的关键因子,评估减贫绩效。据我国2010-2017年31个省份的面板数据,检验社会医疗保险对减轻贫困时空影响的区域差异发现:全国层面,人均社会医疗保险支出每增加1个百分点,贫困发生率降低2.935个百分点,在职参保群体占比每增加1个百分点,贫困发生率降低3.098个百分点,居民参保群体占比每增加1个百分点,贫困发生率降低2.471个百分点,减贫效果显著;但退休参保群体占比的增加则会加剧参保结构老化,并增加贫困发生的可能。省际层面,参保结构对减贫效应的影响具有区域异质性,各参保群体占比的结构变动对不同区域的影响效果具有明显差异。鉴于此,强化顶层设计、优化参保结构、提升统筹层次是提高社会医疗保险减贫效果的现实选择。

Social medical insurance can reduce the medical burden of the insured group. It is an important means to prevent getting and returning to poverty due to illness. The DANP method is utilized to discover the key factors affecting poverty alleviation effectiveness of the social health insurance and to assess poverty alleviation performance. According to the panel data of 31 provinces from 2010 to 2017, we examined the regional differences in the impact of social health insurance on the time and space of poverty alleviation. Our findings revealed that at the national level, with every 1 percent increase in per capita social medical insurance expenditure, the incidence of poverty decreased by 2.935 percent;with every 1 percent increase in the number of active insured groups, the incidence of poverty decreased by 3.098 percent;and with every 1 percent increase in the proportion of the population, the incidence of poverty decreased by 2.471 percent, and the effect of poverty reduction was significant. However, the increase in the proportion of the retired among insured groups exacerbated the aging structure of the insured and increased the possibility of poverty. At the inter-provincial level, the impact of the insurance structure on poverty reduction had regional heterogeneity, and the structural changes in the proportion of each insurance group had significant differences in the effects of different regions. Based on the findings, the realistic options to improve the poverty alleviation effectiveness of social medical insurance are to strengthen the top-level design and optimize the participation structure as well as improve the overall planning level.