商业健康保险如何提升健康人力资本——兼论商业健康险税收优惠政策的选择与调整

How Does the Private Health Improve Healthy Human Capital?——On the Selection and Adjustment of the Tax Subsidy Policy

根据成本-效益分析(CEA)的分析范式,“商业健康险能否以及如何提升健康人力资本”是实施税优政策及调整的逻辑起点。本文在健康效用函数中加入短期和长期健康风险冲击,从理论上推演了“商业健康险一医疗服务利用—健康人力资本”之间的关系,并基于是中国的30个省区市2009—2019年的面板数据进行了实证检验。结果表明,商业健康险会通过医疗服务利用显著提升健康人力资本,商业健康险在提升健康人力资本的过程中存在门槛效应且边际效益逐渐降低,现有的税收优惠政策增强了商业健康险的健康促进效应。相对而言,长期健康险的提升效应更显著,长期医疗治疗服务利用的中介效应更明显,个人医疗负担水平高的地区效果更明显。因此应继续实施商业健康险税收优惠政策以更充分地发挥其促进“全民健康”的作用,同时向长期型健康险、商业健康险供给机构以及医疗负担较重的地区倾斜与调整。

According to the CEA analytical paradigms,"Whether and how can private health insurance promote health"is the bottom logic of tax subsidy policy choice and adjustment.This paper explored to add short-term and long-term health risk shocks into the health utility function,and theoretically deduced the possible relationship between"commercial health insurance-medical service utilization-healthy human capital";and then took an empirical analysis based on based on the inter-provincial panel data of 30 provinces from 2009 to 2019 in China.The results show that:private health insurance will significantly improve healthy human capital through the use of medical services and the effect of long-term health insurance is more significant;there is a threshold effect in the promotion of health human capital by private health insurance and the marginal benefit is gradually reduced and the tax subsidy policy is useful;relatively,the long-term health insurance is more effective,the mediating effect of long-term medical treatment service is more obvious,and the effect is more obvious in the regions with high level of individual medical burden.Based on the findings,we believe that the value of private health insurance should be more affirmed,the tax subsidy policy should be continued in order to give full play to the role of private health insurance in promoting"National Health";furthermore,the tax subsidy policy should be appropriately tilted towards long-term health insurance,health insurance providers and individuals with heavy medical burden.