公共服务均等化视角下城乡居民基本医疗保障受益公平性研究

The Fairness of the Basic Medical Insurance System for Urban and Rural Residents under the Concept of Equalization of Public Services

实现受益公平性是基本医疗保障制度设计的重要原则。本文从公共服务均等化视角入手,以中国城乡基本医疗保险为基础,通过构建基本医疗保险受益公平性理论框架和两阶段Heckman模型,利用2009~2015年CHNS调查数据,对中国城乡居民基本医疗保险受益公平性进行分析。在未限制参保群体样本下,群体间受益差异显著。在模型中加入限制条件后的检验结果表明,不同收入群体在基本医疗保险受益公平性方面仍然存在显著差异,但系数水平降低。引入医疗保健补偿水平进行验证,结果呈现出低收入群体在医疗保健方面具有显著差异性,而这种差异性并未被商业医疗保险及社会医疗救助的补充作用所抵消,且医疗保健支出增多会降低个体住院等费用支出,而高收入群体具有更多的医疗保健支出,从而形成新的不公平。

An import principle of the basic medical insuarnce system is the equity and fairness of benefits.This paper started from the perspective of the equalization concept and was based on China′s urban and rural basic medical insurance system. It constructed the benefit fairness theoretical framework of the basic medical insurance and a two-stage Heckman model,using the data from the 2009-2015 CHNS survey,and analyzed the fairness of the benefits of the basic medical insurance in China. In case of samples of unrestricted insured groups,the benefits between groups are significantly different. After adding restrictions to the model,the test results still show significant differences in the fairness of basic medical insurance benefits among different income groups,but the coefficient level is reduced. Further verification by introducing the level of health care compensation shows that health care of low-income groups are significantly different,and this difference has not been offset by the complementary role of commercial medical insurance and social medical assistance. And the increase in health care expenditure will reduce individual hospitalization and other expenses,while high-income groups have higher health care expenditures,resulting in new inequities.