补充医疗保险对居民消费的影响——来自城乡居民大病保险的证据

The Impact of Supplementary Health Insurance on Residents'Consumption:Evidence from Critical Illness Insurance

促进消费对我国稳定经济增长和构建新发展格局至关重要。本文基于中国家庭追踪调查数据(CFPS),利用地级市层面实施城乡居民大病保险的时间差异,运用双重差分法估计了大病医疗保险对居民消费的影响。结果表明,大病保险使家庭人均消费显著增长了约6%。使用了事件分析法、置换检验、改变回归样本和控制变量等一系列检验后,结论仍保持一致,且这一效果在期初住院率高、储蓄率高以及收入较高的家庭中更明显。进一步地,本文检验了大病保险对居民消费的三种可能影响渠道,发现降低家庭对未来医疗支出风险的预期是大病保险促进家庭非医疗消费进而影响家庭总消费的主要渠道,印证了我国居民对高额医疗支出的担忧是影响消费意愿的重要因素。本文研究对于完善多层次医疗保障体系和促进居民消费具有启示意义。

With increasing uncertainty in the international environment and the long-lasting impact of COVID-19,promoting consumption is crucial to maintaining economic growth and building a new development pattern for China.Reducing expenditure risks and stabilizing residents'expectations are the key to achieving consumption growth.A common explanation for the low consumption rate is that China's medical security system is insufficient:families must save for potential large medical expenses in the future,which will negatively impact current consumption.Supplementary health insurance,especially China's Critical Illness Insurance,which reimburses after the reimbursement of basic health insurance,can help families resist the risk of large medical expenses.Therefore,expanding the coverage of supplementary health insurance and improving the multilevel medical security system are important measures to stabilize families'expectations and promote consumption.In the context of China's deepening reform of the public health insurance system,the policy effect of China's Critical Illness Insurance on consumption has not been systematically and rigorously investigated.Critical Illness Insurance is supplementary to Urban Resident Basic Medical Insurance and New Rural Cooperative Medical Insurance.After the reimbursement of basic public health insurance,at least 50%of large medical expenses borne by individuals are reimbursed.What role does Critical Illness Insurance play in promoting resident consumption?What is the heterogeneity and impact mechanism?This study aims to answer these questions.By using the prefecture-by-prefecture rollout of China's Critical Illness Insurance and data from the China Family Panel Studies,we estimate the impact of supplementary health insurance on resident consumption through the difference-in-differences method.Our results show that Critical Illness Insurance significantly increases per capita consumption by approximately 6%.This effect is more pronounced in families with a higher initial hospitalization rate and higher savings rate,and in wealthier households.Furthermore,we test three potential mechanisms and find that Critical Illness Insurance mainly promotes household non-medical consumption and total consumption by reducing expectations for future health expenditure risks.These findings have policy implications for establishing a multilevel health insurance system and promoting consumption in China.Our work has important academic and policy implications.Academically,this paper makes the following two contributions.First,our results deepen the understanding of Chinese household consumption behavior.Most studies analyzing the influencing factors of resident consumption in the past 5 years focus on the effects of wealth changes.Few studies investigate the role of social security policies.Moreover,these studies focus more on basic pension insurance and basic health insurance,whereas our work studies the impact of supplementary health insurance on consumption and its impact mechanism,which extends the literature on consumption behavior.Second,this study enriches relevant research on supplementary health insurance,especially on China's Critical Illness Insurance.The literature on supplementary health insurance mainly focuses on its impact on health and medical expenses.In contrast,there are few studies on resident consumption,and most of them may suffer from sample selection bias and still have room for improvement in the method of causal identification.As China has achieved full coverage of basic public health insurance,this paper studies the impact of supplementary health insurance on consumption,which has strong policy implications for further promoting consumption and improving China's medical insurance policy.This paper finds that Critical Illness Insurance increases consumption,confirming that Chinese residents'concern about high medical expenses affects their consumption.Although China achieved full coverage of basic medical insurance from 2011 to 2012 and the government's funding for public health insurance keeps growing,the incidence of catastrophic health expenditure remains at a high level.Our results show that developing universal supplementary health insurance and improving the multilevel medical security system are effective measures to stimulate consumption.Especially when China's economic development is facing the triple pressure of shrinking demand,shocking supply,and weakening expectations,improving the medical security system is conducive to reducing residents'concerns related to consumption and stabilizing their expectations,and to further expanding domestic demand and promoting consumption.It is suggested that policymakers consider policies that improve the medical security system and even the social security system as one of the policy options to promote consumption and stabilize the economy.