落户门槛筛选与异地医疗制约——流动人口健康不公平的解释

Selection of Settlement Thresholds and Constraints on Offsite Treatment——An Explanation of Health Inequities of Migrants

流动人口作为城市人口的重要组成部分,其健康公平不仅是促进新型城镇化和城乡融合发展的现实要求,对实现全民健康和共同富裕也具有重要的推动意义。使用2017年全国流动人口动态监测数据,基于健康经济学模型对流动人口健康不公平的表现及形成机制进行验证与解释。研究发现:流动人口与户籍人口存在显著健康差异,且在使用PSM、工具变量和安慰剂检验的情况下依然稳健。当考虑流动时长的影响时,这种健康差异进一步表现为流动人口在流动初期的健康优势及流动后期的健康劣势。机制分析发现,流入地落户门槛对外来人口筛选是形成其健康优势的重要原因;而健康劣势则是由异地医疗方面的制约所致,且参保地点和医疗距离在其中起主要约束作用,基本医保制度则在一定程度上弱化了这种健康差异,促进了流动人口与户籍人口之间的健康公平。

As an important part of urban population,health equity of migrants is not only a realistic requirement to promote new-type urbanization and urban-rural integration development,but also plays an important role in promoting national health and common prosperity.By using the data of China Migrants Dynamics Survey in 2017,this paper validates and explains the manifestation and formation mechanism of health inequities of the migrants based on a health economics model.The study found that significant health differences existed between migrants and registered populations and this result remained robust to the use of PSM,instrumental variables regression,and placebo tests.Further analysis reveals that the selection of migrant population by the threshold of settlement is the important reason for the formation of health advantages,and the health disadvantage is caused by constraints in off-site medical care.Furthermore,the location of enrollment and medical distance play a major binding role,while the basic health insurancesystem weakens this health disparity to a certain extent and promotes health equity between themobile and registered populations.