灵活就业流动人口参保是逆选择还是被选择?

Is the Medical Insurance Participation of the Floating Population with Flexible Employment Adverse Selection or Passive Selection?

全民覆盖是医保制度迈向高质量发展的基础。灵活就业流动人口的参保行为对制度的全民覆盖产生重要影响。基于2017年流动人口动态监测调查数据,以经济人假设分析灵活就业流动人口的健康风险与医保参保行为之间的关系,探寻该群体参保逆选择的存在。研究发现:健康风险对灵活就业流动人口参保决策和险种确定均不产生显著影响,逆选择现象不存在。以政治人的视角进一步分析可知:已参保灵活就业流动人口对居民医保的参保险种和户籍地参保明显的偏向性是医疗保险制度人群分割与地域分割关键矛盾的体现,也是受参保缴费和户籍条件限制而被制度选择的结果。因此,当前医保制度的根本任务在于以现实需求为导向完善医保制度供给,消除灵活就业流动人口的参保障碍。

Universal coverage is the foundation for the high-quality development of the medical insurance system. The insurance participation of floating population with flexible employment has an important impact on the universal coverage of the system. Based on the dynamic monitoring survey data of the floating population in 2017, this paper analyzed the relationship between health risk and medical insurance participation behavior of the floating population with flexible employment by using the economic man hypothesis, and explored the existence of adverse selection. The results show that the health risk has no significant effect on the participation of insurance and the insurance types, and the phenomenon of adverse selection does not exist. From the perspective of political man, further analysis finds that the obvious preference of those have been insured to insured types and insured regions is the embodiment of the key contradiction between population segmentation and regional segmentation in the medical insurance system, and it is also the result of the system selection due to the limitations of insurance payment and the household registration conditions. Therefore, the fundamental task at present is to perfect the supply of medical insurance system in a demand-oriented way and eliminate the barriers to the participation of the floating population with flexible employment.