基本医保均等化能缩小健康差距吗?--来自职工医保省级统筹的证据

Can Basic Health Insurance Equalization Alleviate Health Inequality?--Evidence from the Provincial Coordination of Employee Insurance

目的:探讨实施均等化的基本医疗保险制度能否缩小不同收入群体间的健康差距。方法:本文基于2016年-2020年中国家庭追踪调查(CFPS)数据、各类统计年鉴以及相关政策文件,以职工基本医疗保险省级统筹为视角,采用三重差分法(DDD)考察均等化基本医疗保险政策对不同收入群体间健康差异的影响。结果:(1)相比中高收入群体,省级统筹后低收入群体患慢性病概率显著下降约6.80%,表明省级统筹政策缓解了收入差距所带来的健康不平等状况;(2)低收入群体主要通过提高就医概率和身体锻炼频率改善自身健康状况,医疗费用支出对改善低收入群体健康状况方面的作用并不显著;(3)省级统筹后,退休职工对自身健康状况的评价更高。结论:建议逐步推进基本医保省级统筹,推动医疗卫生服务均等化,加强对弱势群体的保障力度,提高全民健康素养,促进社会公平。

Objective:The paper attempts to explore whether the implementation of a parity health insurance system can reduce the health disparity between different income groups.Methods:Based on the CFPS data from 2016 to 2020,various statistical yearbooks and relevant policy documents,this paper examines the impact of equalized basic health insurance policies on health inequality among different income groups using DDD model through the lens of the provincial coordination of urban employees’basic health insurance.Results:(1)Compared with the middle and high income groups,the probability of chronic diseases in the low income group decreased significantly by about 6.80%after the coordination policy,indicating that the provincial coordination policy alleviated the health inequality;(2)The low income group mainly improved their health status by increasing the probability of medical treatment and the frequency of physical exercise and the effect of medical expenditure on improving the health status of low income groups is not significant;(3)After the provincial coordination,retired employees have a higher evaluation of their own health status.Conclusion:It is recommended to gradually promote the provincial coordination of medical insurance and the equalization of healthcare services,strengthen the guarantee of disadvantaged groups,improve the national health literacy,and promote social equity.