因病致贫:健康冲击如何影响收入水平?——兼论医疗保险的脱贫效应

Poverty Caused by Illness:How Health Shock Affects Income?On the Poverty Alleviation Effects of Medical Insurance

文章采用断点回归方法,以医疗消费比率是否达到灾难性卫生支出发生阈值为处理变量,检验健康冲击对收入的影响效果,并在此基础上分析因病致贫作用路径,评估健康冲击对不同层级人群收入水平的差异化影响,以及医疗保险的脱贫效应。研究发现:当个人上年受到的健康冲击达到灾难性卫生支出这一标准时,个人本年收入水平存在显著向下跳跃,处理效应平均为-12.08%;个人发生灾难性卫生支出通过影响健康水平进一步降低收入水平,这一中介效应约占总效应的28.74%;相比于中高收入人群,低收入人群在发生灾难性卫生支出时,个人收入水平更容易受到冲击,且健康水平中介效应的作用强度更大;医疗保险具有脱贫效应,具体表现为减轻了低收入人群受到健康冲击时收入下降的程度(约24.45%),而中收入人群在受到健康冲击时收入已不再显著下降。

This paper uses the regression discontinuity method to test the effect of health shock on income by considering whether the medical consumption rate reaches the threshold of catastrophic health expenditure as the processing variable.On this basis,it analyzes the path of poverty caused by illness,evaluates the differential impact of health shock on the income level of different levels of people,and the effect of health insurance on poverty alleviation.The results are that when the health impact of last year reached the standard of catastrophic health expenditure,the income level of individuals in this year had a significant downward jump,and the average treatment effect was-12.08%;the personal catastrophic health expenditure further reduces the income level by affecting the health level,which should account for about 28.74%of the total effect;compared with the middle-and high-income groups,low-income groups are more vulnerable to the impact of the personal income level when catastrophic health expenditure occurs,and the intermediary effect of the health level is more intense;medical insurance has the effect of poverty alleviation,which is manifested in reducing the income decline of low-income people when they are impacted by health shock(about 24.45%),while the income of middle-income people is no longer significantly reduced when they are impacted by health shock.