人口老龄化与商业医疗系统转型

Aging and the Structural Transformation of Health System

本文从实证热点出发,考察在我国老龄化日益加深的过程中,健康状况不确定性增加,医疗费用大幅提高,由于与之配套的商业医疗及保险体系仍不成熟,致使市场不确定性日益增加,商业医疗体系的不成熟表现在医疗供给的不足和医疗保险的缺失。医疗供给不足使人们积累健康资本的能力下降,从而降低劳动能力和劳动收入;商业医疗保险的缺失又无法对冲掉健康不确定性所带来的风险,导致家庭部门只能通过有限的储蓄来平滑消费。通过建立一个世代交叠,伴有劳动冲击、健康冲击和内生健康资本积累的模型,引入多部门生产模型来探讨商业医疗体系的完善对福利产生的影响。将生产部门分为最终商品生产、公共医疗生产和商业医疗生产。同时,引入相应的公共医疗保险和商业医疗保险项目。研究发现,若放开商业医疗体系,即允许资本在各个生产部门之间自由流动,则商业医疗供给将大幅提高,与此相匹配的商业保险规模也随之扩大。家庭部门一方面有更多更便宜的医疗消费来积累健康资本,另一方面,又有足够的保险来抵御健康风险,进而达到福利提高的目的。对于不同收入群体的家庭而言,中等收入家庭福利增加最大,因为他们更多地转向商业医疗和保险部门;而中等收入家庭的转移使得仍然选择公共医疗部门的低收入家庭有更多资源,因此他们的福利也随之增加。

In the process of aging,the uncertainty of health also becomes more severe,health expenditures increase.Due to the fact that our health system is still immature,there involve increasingly more uncertainty in the market.Specifically,the immaturity of the commercial medical system is manifested in the lack of medical supply and medical insurance.Insufficient medical supply means that the ability to accumulate health capital decreases,thereby reducing labor capacity and labor income;and the lack of commercial medical insurance cannot offset the risks brought by health uncertainty,resulting in the household sector only through limited savings to smooth consumption.We build a model of overlapping generations with labor shocks,health shocks,and endogenous health capital accumulation,and introduce a multi-sector production model to explore the impact of the improvement of the commercial medical system on welfare.Specifically,we divide the production sector into final production sector,public medical production,and commercial medical production sector.At the same time,we also introduce corresponding public medical insurance and commercial medical insurance projects.We found that if the commercial medical system is liberalized,that is,the free flow of capital among various production sectors is allowed,the commercial medical supply will be greatly improved,and the scale of commercial insurance will also expand.On the one hand,the household sector has more and cheaper medical consumption to accumulate health capital,and sufficient insurance to protect against health risks,thereby achieving the purpose of improving welfare.For households in different income groups,middleincome households benefited the most,as they shifted more to the commercial health and insurance sectors;while the shift of middle-income households left more resources for lower-income households who still opted for the public health sector,so their benefits also increased.