城乡医保统筹对农村流动人口消费的影响——基于倾向得分匹配的反事实估计

Impact of Urban-rural Medical Insurance Integration on the Consumption of Rural Floating Population: Based on the Counterfactual Estimation of the Propensity Score Matching

建立统一完善的医疗保障体系是我国医疗体制改革的重要目标之一,城乡医保统筹则在改革的进程中迈出了至关重要的一步,其对缩小城乡保障差距、实现城乡一体化发展有着重要意义。本文基于2017年流动人口动态监测数据(CMDS),实证分析城乡医保统筹对农村流动人口消费的影响,并得到如下结论:以参加新农合的个体为参照组的研究发现,城乡医保统筹能够促进农村流动人口消费,处理效应模型表明其程度约为3.65%;分位数回归结果显示,这种促进效应对中等消费水平的农村流动人口效果尤为明显;机制检验则验证了预防性储蓄机制的存在;通过对不同年龄、收入以及居留意愿的农村流动人口进行异质性分析发现,城乡医保统筹对中老年、中高收入以及具有居留意愿的农村流动人口效果更为显著。因此,我国医保改革的重点方向在于进一步扎牢医疗保障网,关注一些在实际中游离于制度外的群体。通过弥合制度间待遇差距、提升统筹层次以及推进家庭联保等方式打下保障个人健康权益的制度基础,从而提振消费信心,充分释放潜在的消费需求。

Establishing an integrated and perfect medical security system is one of the important goals of China’s medical system reform. Urban-rural medical insurance integration has played a crucial role in it, which might have a significant impact on narrowing urban-rural medical security disparity and realizing the development of urban-rural integration. Based on data of China Migrants Dynamic Survey(CMDS) in 2017, this paper gives an empirical analysis on the impact of urban-rural medical insurance integration on the rural floating population’s consumption. The treatment effect model, whose reference group is the new rural cooperative medical system participant, indicates that urban-rural medical insurance integration can stimulate rural floating population’s consumption by 3.65%. The quantile regression shows that the rural floating population with medium consumption level is the greatest beneficiary and the mechanism test verifies the existence of precautionary saving.We further analyzed the heterogeneity impact on rural floating population with different age, income and dwelling willing. It is found that urban-rural medical insurance integration has a more significant effect on middle-aged people and elderly, middle and upper income groups or those with dwelling willing. Therefore, the key direction of China’s medical insurance reform is to strengthen it’s support capability and concentrate on those who have an obstacle to utilize medical insurance. To boost consumer confidence and fully release the potential consumption demand, we can lay the root for protecting individual’s health right through bridging the gap between different medical insurance, raising overall plan level of medical insurance, and promoting family-based joint-insurance.