城乡医保统筹对农村居民支出水平的影响——基于自评健康的中介效应

Study on the Effect of Urban-Rural Health Insurance Integration on the Level of Rural Residents Expenditures Based on the Mediating Effects of Self-Assessed Health

目的:探讨城乡医保统筹对农村居民支出水平的影响以及自评健康的中介作用。方法:选取CHARLS2013年和2018年两期面板数据,共7486个样本,应用双重差分(DID)分析和中介效应检验模型探讨城乡医保统筹、自评健康以及农村居民支出水平之间的关系。结果:Logistic模型结果显示参与城乡医保统筹能使农村居民的生产支出和医疗支出分别降低35.5%(P<0.001)和19.3%(P<0.001),同时能使其生活支出和总支出分别提高13.7%(P<0.05)和26.1%(P<0.1);通过机制分析发现,自评健康在城乡医保统筹与农村居民支出的影响链路中起到了中介作用,尤其对医疗支出起到了完全中介作用。结论:城乡医保统筹既能直接影响农村居民的支出水平,也能通过提高自评健康水平来产生影响。因此,要通过加大城乡医保统筹力度,优化城乡医保的顶层设计,增加农村居民的健康支持,从而进一步提高农村居民的民生福祉。

Objective To explore the impact of urban-rural health insurance integration on the expenditure level of rural residents and the mediating role of self-assessed health.Methods The panel data of CHARLS in 2013 and 2018,with a total of 7,486 samples,were selected to explore the relationship among urban-rural health insurance integration,self-assessed health,and the level of rural residents'expenditures by applying difference-in-differences(DID)analysis and mediation effect test model.Results The results of logistic model showed that participation in urban-rural health insurance integration could reduce rural residents'production and medical expenditures by 35.5%(P<0.001)and 19.3%(P<0.001),respectively,and increase their living expenditures and total expenditures by 13.7%(P<0.05)and 26.1%(P<0.1),respectively.Mechanism analysis found that self-assessment of health played a mediating role in the chain of influence between urban-rural health insurance coordination and rural residents'expenditures,especially played a fully mediating role in medical expenditures.Conclusion The urban-rural health insurance integration can both directly influence the level of rural residents'expenditure and indirectly influence it through increasing the level of self-assessed health.Therefore,it is important to increase the health support for rural residents by increasing urban-rural health insurance coordination and optimizing the top-level design of urban-rural health insurance,so as to further improve the well-being of rural residents.