城乡居民医保整合对农村家庭灾难性卫生支出的影响研究

The Effects of Urban-Rural Medical Insurance Integration on Rural Households'Catastrophic Health Expenditure

目的:评估我国城乡居民医保整合对改善农村家庭灾难性卫生支出的作用,有针对性地提出城乡居民医保整合的优化策略。方法:基于中国家庭追踪调查2010—2018年5期追踪数据,采用双重差分倾向得分匹配模型检验城乡居民医保整合对农村家庭灾难性卫生支出的影响。结果:我国城乡居民医保整合显著降低了农村家庭灾难性卫生支出的发生率,健康水平、人力资本支出和家庭资产积累是发生率降低的重要作用渠道。结论:建议持续推进城乡居民医保整合、因地制宜制定医保统筹政策、将灾难性卫生支出纳入农村居民返贫致贫监测预警指标体系。

Objective:To evaluate the effect of urban-rural integrated medical insurance on rural households'catastrophic health expenditure(CHE),thereby proposing targeted optimization strategies for the integration.Methods:Based on the five tracking data of the China Household Tracking Survey(CFPS)from 2010 to 2018,Process Specification Model-Dynamic Integrity Dimension(PSMDID)was used to empirically test the impact of urban-rural integrated medical insurance on rural households'catastrophic health expenditures.Results:The urban-rural integrated medical insurance system significantly reduces the incidence of CHE in rural households.Mechanism testing indicates that health levels,human capital expenditures,and household asset accumulation are important channels of action.Conclusion:It is suggested to continuously promote the urban-rural integrated medical insurance system,formulate comprehensive policies for medical insurance according to local conditions,and incorporate catastrophic health indicators into the detection and warning indicator system for rural residents returning to poverty.