城乡医保整合政策对农村中老年人医疗负担的影响

The impact of urban-rural health insurance integration policy on the medical burden of rural middle-aged and elderly people

使用中国健康与养老追踪调查数据(CHARLS),基于双重差分的分析框架采用Heckman样本选择模型,实证评估了城乡医保整合政策对农村中老年人医疗负担的影响。研究发现:城乡医保整合政策有助于减轻农村中老年人医疗负担,并且采取“一制多档”整合模式比“城乡一档”整合模式的效果更好。异质性分析表明:在年龄分组上,城乡医保整合政策及“一制多档”的整合模式有利于降低65岁以上高龄老年群体的医疗负担,但对45~54岁的中年人群体影响不显著;在收入分组上,实施城乡医保整合政策对于减少中等收入群体医疗负担的效果好于低收入和高收入群体,但采用“城乡一档”的整合模式对低收入群体医疗负担减少效果不显著。总体而言,实施城乡医保整合政策减轻了农村中老年人医疗负担,对缓解城乡医疗保障差距有促进作用,政策实施达到预期效果。

By employing the data set of China Health and Retirement Longitudinal Study(CHARLS)and using the Heckman sample selection model under Difference-in-difference(DID)method,this paper empirically evaluated the impact of urban-rural health insurance integration on the medical burden of middle-aged and elderly people in China.The results showed that,the urban-rural health insurance integration policy helped reduce the burden of medical expenses of middle-aged and elderly patients in the rural areas.Furthermore,the effect of“single system,multi-standard”mode was better than the“single system,urban and rural single-standard”mode.Heterogeneity analysis indicated that when grouping by age,urban-rural health insurance integration policy and the“single system,multi-standard”mode helped reduce the medical burden of the elderly over 65 years old,but had no significant impact on the age group of 45~54.When grouping by income,urban-rural health insurance integration policy was more efficient in reducing the medical burden of the middle-income group than that of low-income and high-income groups.However,the“single system,urban and rural single-standard”integration mode had no significant effect on reducing the medical burden of low-income groups.In summary,urban-rural health insurance integration has achieved the expected effect of reducing the medical burden of rural middle-aged and elderly people and narrowing the gap between urban and rural medical security.