医疗保险对农村居民消费的影响:经济效应还是心理效应

The Influence of Medical Insurance on the Consumption of Rural Residents:Economic or Psychological Effects

促进农村居民消费是扩大内需、促进经济高质量发展的迫切要求。基于CHARLS的四期面板数据,实证分析医疗保险对农村居民消费的影响。研究发现,医疗保险显著增加了农村居民的非医疗消费,且主要体现在生存型消费;健康冲击在其中起着显著调节作用,促使农村居民非医疗消费显著降低43.2%;医疗保险的消费效应在低收入群体中并不显著,住院病人中尚存在“越报销,越不敢消费”的现象。机制检验表明,医疗保险在促进医疗服务利用的同时并未显著减少自付费用和降低自费负担,即减负效应不显著;基于安全预期和幸福感的中介效应检验高度显著,表明心理效应依然是医疗保险促进农民居民消费的关键机制。研究指出,未来公平性应成为医保改革的首要价值导向;在保障水平提升空间有限的情况下,应大力控制医疗费用的不合理增长以提升基金的使用效率;要深化以分级诊疗为重点的医疗卫生体制改革。

Promotion of consumption among rural residents is an urgent requirement for expanding domestic demand and promoting high-quality economic development.This paper empirically analyzes the impact of medical insurance on rural residents'consumption based on the four-phase panel data of CHARLS.It is found that medical insurance significantly increases non-medical consumption among rural residents,with the main increase being in subsistence consumption;health shocks play a significant moderating role,leading to a notable decrease of 43.2%in non-medical consumption among rural residents;the consumption effect of medical insurance is not significant in low-income groups,and there is a phenomenon of“The more reimbursements one gets,the less willing of consumption”among hospitalized patients.Mechanism test indicates that because medical insurance does not significantly reduce out-of-pocket expenses or decrease the burden of out-of-pocket payments while promoting the utilization of medical services,the burden-reducing effect of medical insurance is not significant.The mediating effect test based on sense of security and happiness is highly significant,indicating that psychological effect is still the key mechanism for medical insurance to promote the consumption of rural residents.The article proposes that fairness should be the primary value orientation of medical insurance system reform.In the case of limited space for the improvement of the level of security,it is proposed to vigorously control the unreasonable growth of medical expenses to improve the efficiency of the use of funds,and deepen the reform of the medical and health system focusing on hierarchical diagnosis and treatment.