大病保险、医疗服务升级与农民健康

Critical Illness Insurance, Medical Service Upgraded and Farmers’ Health

“健康中国2030”规划纲要明确了健康对经济社会发展的重要作用,在新型农村合作医疗制度未能显著改善农民健康的背景下,研究农民健康水平的提升机制具有重要意义。本文聚焦2012年8月开始试点实施的城乡居民大病保险制度,基于2011—2015年中国健康与养老追踪调查(CHARLS)数据,以样本所在城市是否试点实施农村大病保险作为依据构造“农村大病保险”参保变量,运用计量模型实证检验农村大病保险对农民健康的影响效应及机制。实证结果显示,试点农村大病保险使农民自评健康显著提高0.08个单位,并且在对健康水平和农村大病保险等变量进行重新调整的情形下,实证结果依然稳健。异质性分析结果显示,农村大病保险对低收入群体的健康促进作用更大,并且对社区内有医疗点的群体影响效果更为显著。机制分析结果显示,对于需住院群体而言,农村大病保险通过促进农民做出住院决策进而改善了健康;而对于住院群体,农村大病保险通过促进农民选择级别更高的县区级医院进而改善了健康。为进一步提高农民健康水平,应丰富农村大病保险的筹资主体,引入个人缴费和财政补贴,在扩大大病保险基金规模的前提下,进一步提升大病保险待遇水平;同时,应改善农村基层医疗资源分配,提高农民基层医疗服务可及性和服务水平。

“Healthy China 2030”planning outline clarifies the important role of health in the economy and social development.Under the background that the new rural cooperative medical system fails to significantly promote farmers’health,it is of great significance to study the mechanism of improving farmers’health level.This paper focuses on the critical illness insurance system for urban and rural residents,which has been implemented on a pilot basis since August 2012.Based on the data of China Health and Retirement Longitudinal Study(CHARLS)from 2011 to 2015,this paper constructs the insured variable“rural critical illness insurance”according to whether the cities where the samples were located had implemented rural critical insurance.This paper empirically tests the impact and mechanism of rural critical illness insurance on farmers’health.The empirical results show that participating in the rural critical illness insurance increases farmers’self-assessed health by 0.08 units,and the empirical results are still robust even when variables such as health level and rural critical illness insurance are readjusted.Heterogeneity analysis shows that the health promotion effect of rural critical illness insurance on low-income groups is greater,and the effect of rural critical illness insurance on groups with medical centers in the community is more significant.The results of mechanism analysis shows that,for the population in need of hospitalization,the rural critical illness insurance improved the health by promoting farmers to make hospitalization decisions.For the inpatient population,rural critical illness insurance improves health by encouraging farmers to choose higher-level county and district hospitals.In order to further improve the health level of farmers,it is necessary to further enrich the financing body of rural critical illness insurance,introduce individual payment and financial subsidies,and further improve the security level of critical illness insurance under the premise of expanding the scale of critical illness insurance fund.At the same time,we should improve the distribution of rural primary medical resources and improve the accessibility and level of rural primary medical services.