谁没有参保?中国城乡居民医疗保险参保的人群特征研究

Who are the Uninsured?An Analysis of the Population Characteristics of China's Urban and Rural Resident Basic Medical Insurance Enrollees

目前,中国城乡居民医疗保险未参保人群的绝对规模庞大。本文基于多源数据,从宏观层面上描述了中国城乡居民医疗保险参保的人群特征。从类别上看,乡村人口、非流动人口和就业人口的参保率分别远高于城市人口、流动人口和非就业人口。从年龄分组看,年龄与参保呈M型结构,6-14岁少年、50-80岁成年人参保率较高,6岁以下幼儿、15-26岁青少年以及80岁以上老年人参保率较低。研究发现,征缴政策执行能力、央地财政补助分担机制、个人定额缴费、凭户口参保、学校监督、信息获取能力等是影响参保的制度性和体制性因素。为此,本文建议,加强对社区居委会征缴保费的激励约束,提高中央和省级财政在城乡居民医疗保险财政补助中的作用,将个人定额缴费改为定比缴费或比例缴费,全面实行新生儿出生当年免费参保政策,允许尚未办理户口的幼儿以其父母身份证号为基础参保,充分发挥学校的参保监督作用并减少辍学学生和毕业生漏保现象,加大对信息闭塞群体的政策宣传等。

The Urban and Rural Resident Basic Medical Insurance(URRBMI)program in China still leaves a significant number of people uninsured.This paper uses data from multiple sources to analyze the characteristics of URRBMI enrollees.The participation rates are higher for rural residents,the nonfloating population,and the employed population compared to their urban counterparts,the floating population,and the non-working population,respectively.The relationship between age and participation rate shows an M-shaped structure,with higher participation rates for teenagers aged 6-14 and adults aged 50-80,and lower participation rates for children under 6 years old,young people aged 15-26,and the elderly over 80 years old.Factors that influence insurance enrollment include the ability to collect contributions,government subsidies,individual contributions,household registration,school supervision,and access to information.This paper proposes strengthening the incentive for neighborhood committees to collect insurance contributions,increasing subsidies from central and provincial governments,replacing flat-rate contributions with percentage-based contributions,providing free coverage to newborns in their birth year,allowing children who have no ID numbers to be covered using their parents'ID numbers,giving full play to the school's role in expanding insurance coverage,extending coverage to those who dropped out and graduates,and improving understanding of medical insurance policies among ill-informed residents.