中国成年人医疗保险未参保状况及影响因素研究

The Medically Uninsured Chinese Adults: Trends and Determinants

为了扩大医疗保险覆盖率,中国政府相继实施了城镇职工基本医疗保险、新型农村合作医疗、城镇居民基本医疗保险制度。利用中国家庭追踪调查2010、2012、2014、2016年数据,本研究考察了成年人医疗保险未参保的发生率及未参保的影响因素。描述性统计结果显示,尽管中国近年来医疗保险覆盖率明显增加,但到2016年仍有约7%的成年人没有被医疗保险覆盖。从社会经济地位、逆向选择、制度分割(属地管理)的角度,本研究运用多元统计分析了未参保的影响因素。研究发现:收入、教育水平、过去半年是否患过慢性病、过去一年是否住过院大体上都与未参保显著负相关,表明社会经济地位低和逆向选择问题是构成全民医保实现的障碍;人口(非户籍)流动与未参保显著正相关,表明医保制度的分割性会限制人们参保;在社会保障建设不断推进、政府日益关注弱势群体医疗保障问题的背景下,近年来社会经济水平低和医保制度分割对参保的阻碍作用有所下降。

To expand the coverage of medical insurance nationwide, the Chinese government successively implemented the Urban Employee Basic Medical Insurance Scheme, New Cooperative Rural Medical Scheme, and Urban Resident Basic Medical Insurance Scheme in the past two decades. Using the data from the China Family Panel Studies conducted in 2010, 2012, 2014 and 2016 respectively, we examined the prevalence and social determinants of health non-insurance among Chinese adults. Descriptive results showed that, despite the great increase in the insurance coverage rate, by 2016 about 7 per cent of Chinese adults were still uninsured in any health insurance scheme. Based on the perspectives of ’’socioeconomic status’ ’, ’’adverse selection’’, and ’’institutional segmentation(localized administration)’’, we conducted multivariate analyses of social determinants of non-insurance. We found that income, education, inpatient treatment in the last year, and chronic disease in the past half year are all negatively associated with non-insurance, indicating that socioeconomic disadvantages and adverse selection constitute potential barriers for achieving universal insurance coverage. We also found that non-hukou migration is positively associated with noninsurance, indicating that the segmentation of the health insurance system hampers full insurance participation. Along with the government’s effort in the development of social security and the endeavor of the medical care access of the socioeconomically disadvantaged, we found some evidence indicating that the infl uences of socioeconomic status and the segmentation of health insurance system on access to insurance have been in decline. Taken as a whole, these findings are enlightening to policymakers who are intent on improving the health insurance system in China.