城乡居民医保整合是否抑制了农村中老年人健康损耗?

Does Integrated Medical Insurance System Curb the Health Impairment of the Middle-Aged and Elderly People in Rural China?

本文基于CHARLS全国调查数据,运用渐进性双重差分方法,考察了城乡居民医保整合对农村中老年人健康损耗的影响。研究发现,相对于未整合地区而言,城乡居民医保整合有效缓解了农村中老年人的行动能力损耗,但并未对其认知能力损耗产生显著影响。基于年龄分组的异质性分析结果表明,“一制多档”模式抑制了农村中年群体与低龄老人群体的行动能力损耗,而“城乡一档”模式则对农村高龄老人的行动能力损耗产生了抑制作用。无论是“一制多档”模式还是“城乡一档”模式,对不同年龄群体认知能力损耗的抑制效果甚微。基于贫困分组的异质性分析结果表明,“一制多档”模式和“城乡一档”模式均对非贫困组行动能力损耗具有更强的抑制作用,但“城乡一档”模式在降低认知能力损耗风险方面呈现出更明显的“益贫”效果,这意味着不同整合模式在抑制不同群体健康损耗方面各具优势。此外,城乡居民医保整合对农村中老年人行动能力与认知能力损耗的抑制效应随实施时间的推移不断增强。总而言之,若要通过社会医疗保险制度的深化改革来破解农村居民因病致贫、因病返贫的困境,需要因地制宜地实施有差别的城乡医保整合模式,重点关注农村弱势群体的健康资本损耗问题,巩固脱贫攻坚成果。

Using a quasi-natural experiment,this article empirically verifies the impact of Integrated Medical Insurance System(IMIS)on health impairment of the middle-aged and elderly people in rural China,by employing the dataset of China Health and Retirement Longitudinal Study(CHARLS)and Difference-in-difference(DID)method.The results illustrate that,firstly,compared with those non-integrated areas,IMIS can effectively alleviate the loss of action ability of rural middle-aged and elderly people,but has no significant impact on their cognitive ability loss.Secondly,based on a heterogeneity analysis of age groups,the results show that the“single system,multi-standard”model significantly inhibits the loss of action ability of middle-aged and younger elderly groups,while the“single system,single-standard”model significantly inhibits the loss of action ability of the elderly in rural areas.Whether it is the“single system,multi-standard”model or the“single system,single-standard”one,the inhibition effect on cognitive impairment of different age groups is rather limited.Based on the heterogeneity analysis of poverty groups,the results show that both integrated modes have a stronger inhibiting effect on the impairment of action capability of non-poverty groups.however,the“single system,single-standard”mode has a more obvious“pro-poor”effect in reducing the risk of cognitive ability impairment.These results illustrate that each integration mode have its own advantages in reducing the risk of health impairment of different groups.Furthermore,the curbing effects of IMIS on their health impairment is increasing with the implementation time.In a word,if we want to alleviate the problem of illness-associated impoverishment of rural residents through the deepening reform of social medical insurance system,we need to implement the different integration mode of urban and rural medical insurance according to local conditions,focus on the loss of health capital of rural vulnerable groups,and consolidate the achievements of poverty alleviation.