中国基本医疗保险、户籍差异与新生儿健康——以上海市为例

Differences in Basic Medical Social Security,Household Registration and the Newborn Infants’Health in China:An Analysis of the Data Collected in Shanghai

医疗保险作为各国的主要卫生政策,对新生儿健康具有重要影响。国外对医疗保险促进新生儿健康做了详尽研究,但国内关于此领域的研究尚不多见。中国城乡"二元"经济体制导致的医疗保障失衡现象极有可能会造成新生儿在健康水平方面的户籍差异。本文利用孕产妇及新生儿的病历数据,采用倍差法以及倾向性分值匹配与倍差法结合的方法,探讨新生儿基本医疗保险受益性的户籍差异。研究发现:流动孕产妇的参保率低于本地居民且流动人口新生儿的健康状况远低于本地人口新生儿。对于参保后人群的研究发现,参保后流动人口新生儿的医保受益性明显高于本地人口,此结果根据新生儿性别以及产次分层后,结果依旧稳健。文本进而探究了中国基本医疗保险影响新生儿健康的作用机制,发现中国基本医疗保险通过改善孕妇在孕期的健康行为以促进新生儿健康。因此,中国基本医疗保险应适度对流动孕产妇倾斜支持,推进医疗保险"预防优先"的理念,控制事前道德风险,以促进该群体的母婴健康。

Medical social security is one of the major national health policies across the world with significant effects on newborn infants’health.There are abundant relevant studies oversea,while it is few in China.The imbalance of medical security caused by the"dual"social economic system of urban and rural areas in China is likely to result in the inequity of infant health.We analyzes the 133,358 birth data from Shanghai Maternity and Infant Health Hospital to exam the differences in the newborn infant’s health status caused by the difference in membership of medical social security system by the approach of difference in differences(DID)and propensity score matching(PSM).The findings show that the migrant women’maternal participation in medical social security of the urban household registration is lower than that of the local urban residents,and the health status of the migrants’newborn infants is much lower than that of the local urban newborn infants.However,the migrant mothers’joining in medical social security in the urban can more significantly improve their infant’s health compared with the local urban residents.These conclusions are further confirmed by the classification of infants’gender and parity.Meanwhile,the further mechanism analysis show that the medical social security in the urban can increase the utilization of medical services and cares for pregnant women and thus improve the infant’s health.We suggest that the social medical security system can provide more supports to the migrant women to strengthen their prenatal education and cares,to decrease the ex-ante moral hazards,and so as to promote the maternal and infant health of migrants.