中国城乡居民基本医保整合政策对商业健康保险发展的影响——基于PSM-DID方法的实证分析

The Impact of the Integration of the Basic Medical Insurance System for Urban and Rural Residents on the Development of Commercial Health Insurance in China:Evidence-based Analysis Based on the PSM-DID Method

合并2015年、2017年的中国家庭金融调查(CHFS)微观数据,结合宏观层面的居民医保基金人均筹资和人均财政压力数据,采用倾向得分匹配和双重差分(PSM-DID)方法进行分析,结果发现城乡居民基本医保整合会显著提高居民商业健康保险需求。进一步结合理论模型和调节效应机制分析得到,整合政策出台带来的居民医保待遇提高会同时增加筹资压力和财政负担,而财政压力的提高会倒逼商业健康保险的发展,以缓解基本医保基金的运行压力。

The commercial health insurance is an important part of China’s multi-level medical security system and an important supplement for residents in addition to the basic medical insurance,which is of great significance to protect the health of residents.The introduction of the policy in January 2016 is conducive to improving the basic medical security benefits for residents,and the improvement of residents’medical security benefits may lead to higher funding pressure as well as a greater financial burden,and the financial pressure may force the development of the commercial health insurance to ease the pressure on the operation of health insurance funds.Therefore,the integration policy may have promoted the development of the commercial health insurance in China to some extent.This paper,from the perspective of the demand for commercial health insurance,combines theoretical model and empirical analysis to discuss in depth whether the introduction of the integration policy has promoted the development of the commercial health insurance in the press of the need for the increase in residents’security benefits and the ever-increasing fiscal burden.At the theoretical level,based on the Ramsay-Cass-Kupmans model,this paper constructs a theoretical model of the impact of urban and rural residents’health insurance fund financing and fiscal pressure on commercial health insurance from the perspective of residents’individual behavioral decisions,assuming that the utility function of individuals is constant relative to the risk aversion coefficient.The results of the theoretical model derivation are as follows:the greater the growth of the financial pressure,the greater the growth rate of the commercial health insurance demand;the greater the elasticity of residents’health insurance fund financing expenditure to the financial pressure,the greater the growth rate of the commercial health insurance,and the better the development of the commercial health insurance.Furthermore,based on the literature review and the theoretical model analysis,this paper merges the micro-panel data of China Household Finance Survey(CHFS)in 2015 and 2017,and combines the macro-level data on the per capita financing of the residential health insurance fund and the per capita fiscal pressure,and adopts the Propensity Score Matching Double Difference(PSM-DID)method and the mechanism analysis method of the moderating effect to examine the effect of the integration policy on the mechanism of the impact of the integration policy on the demand for the commercial health insurance.The empirical results,which are proven to be valid by robustness test,reveal the moderating role of the per capita financial pressure in the impact of the residential health insurance integration policy on the development of the commercial health insurance.Finally,the research conclusions of this paper show that the integration policy of basic health insurance for urban and rural residents in China has a significant positive effect on the development of the commercial health insurance,and this effect is realized through the combined effect of residents’health insurance financing and the financial pressure.That is,the integrated policy will raise the level of residents’health insurance coverage,and at the same time,it will bring about a rise in the funding pressure and the financial pressure,and the increase in the financial pressure will force the development of the commercial health insurance so as to alleviate the pressure of the Health Insurance Fund operation caused by the increase of investment.The final effect of the interaction between the two is that the integration policy significantly promotes the development of the health insurance.The conclusions of this paper are of great significance at the time when China is seriously affected by the COVID-19 pandemic.During the epidemic period,China temporarily introduced a series of emergency medical security measures,and increased a large amount of fund expenditures,which has put greater pressure on China’s health insurance fund.Therefore,this paper puts forward some important suggestions such as attaching importance to the development of the commercial health insurance,constructing a multi-level medical security system in China,and promoting the synergistic development of the commercial health insurance and the basic medical insurance system.