基本医疗保险制度能否改善农民工的相对不平等

Can the Basic Medical Insurance System Improve the Relative Inequality of Migrant Workers?

本文利用中国流动人口动态监测调查(CMDS)2017年数据,分析在全民医保背景下,不考虑重复参保时参加不同基本医疗保险对Kakwani指数测度的农民工相对不平等的影响。研究发现:城职保、城居保显著改善了农民工的相对不平等,而新农合则加剧了农民工的相对不平等。进一步采用工具变量和PSM方法解决内生性问题,以及采用分位数回归、替换关键被解释变量,并分不同群体、流动范围分析之后,城职保和新农合的影响作用依然稳健,而城居保在部分模型中不显著。分位数回归结果表明,新农合仅扩大了低收入农民工的相对不平等,城职保仅改善了低收入农民工的相对不平等,而城居保对高收入、低收入农民工的相对不平等均存在改善作用。究其原因主要是,不同医疗制度的受益公平性(医疗服务利用、医疗费用报销比)存在差异,城职保的受益公平性好于城居保和新农合,而城居保的受益公平性又略好于新农合。

Based on the data of China Migrants Dynamic Survey(CMDS)in 2017,this paper analyzes the influence of different basic medical insurance on the relative inequality(measured by Kakwani index)of migrant workers under the background of universal health insurance coverage.It is found that the Urban Employee Basic Medical Insurance(UEBMI)and the Urban Resident Basic Medical Insurance(URBMI)significantly improve the relative inequality of migrant workers,while the New Cooperative Medical Scheme(NCMS)aggravates the relative inequality of migrant workers.Furthermore,adopted IV and PSM method to solve the endogenous problems,and used the quantile regression and replace the key explained variables,and divided into different groups and migration scope,the effects of UEBMI and NCMS are still robust,while the URBMI is not significant in some models.In addition,the quantile regression results show that the NCMS only increases the relative inequality of low-income migrant workers,the UEBMI improves the relative inequality of low-income migrant workers,while the URBMI can improve the relative inequality of high-income and low-income migrant workers.The main reason is that there are differences in benefit equity(health service accessibility,reimbursement ratio of medical expenses)among different basic medical systems.The benefit equity of the UEBMI is better than the URBMI and NCMS,while the URBMI is slightly better than the NCMS.The conclusion of this article provides an empirical basis for further improving the basic medical system in China.