Study on the improvement of the urban and rural residents endowment insurance system

Urban and rural endowment insurance system as a whole is to perfect the system of social security system in our country an important aspect, is to complete the task of the endowment insurance system covering both urban and rural residents need to move. However the urban and rural endowment insurance system as a whole cannot be simply understood as an unified system of urban and rural endowment insurance, simply cannot understand the endowment insurance system for urban and rural areas is the same as or standard is the same. In our country, because of the long-term existence and development of the urban and rural dual structure, the level of productivity, economic level, between urban and rural income levels there are significant differences in aspects, also directly caused a split between urban and rural social security system, including endowment insurance system. At present, our country＇s endowment insurance system takes the form of government subsidies combined with individual pay cost, which improve and perfect the endowment insurance system in China is in the form of the old-age insurance system in the direction of the long term hard work. On the one hand, government should continue to improve the system of town worker is basic endowment insurance, at the same time into the peasant workers＇ endowment insurance system, integrating the endowment insurance system for urban and rural worker; Through further, on the other hand, the new farming maintain is a new type of rural social endowment insurance system and “city ju bao”, urban social endowment insurance system integration, promote urban and rural residents endowment insurance system for better implementation.

Literature review of the basic medical insurance of urban and rural integration

To set up the nation＇s covering medical insurance syslem and to the realization of the basic medical insurance of urban and rural integration, is the inevitable trend in the development of China＇s medical insurance reform, as well as it is also a key step. In recent years, the state promulgated a series of policies in promoting urban and rural medical insurance and many cities took the lead to reform form the medical insurance pattern with local characteristics. All of these are helpful for our country to realize the integration and providing valuable experience. The target of the article is to maintain the public cause of medical and health, to solve the problem of high cost of urban and rural residents to see a doctor. As well as to realize the objections of disease pro^ection, convenience, cure spends less.

Comparison of breakfast consumption in rural and urban among Inner Mongolia Medical University students

Objective: The aim of current study was to investigate breakfast consumption between rural and urban among Inner Mongolia Medical University students, China. Method: From December 2010 to January 2011, a cross-sectional survey was conducted among medical students in the Inner Mongolia Medical University using a self-administered questionnaire. X2 was used to identify the differences between rural and urban. Result: The prevalence of breakfast consumption was 70.95%. The prevalence of breakfast in rural was higher than that in urban (72.09% vs. 69.78%). Breakfast consumption prevalence among male students in rural was higher 7.4% than those of students in urban. Students in Mongolian ethnic in rural were more likely to eat breakfast than Mongolian students in urban. The prevalence of breakfast decreases with grade increase both urban and rural. Students with good physical condition were more likely to eat breakfast compared with students with poor physical condition. Conclusion: The prevalence of regular breakfast consumption in rural was higher than that in urban. However, the prevalence of eating breakfast declined faster in rural than that in urban. Our study findings could help health care professionals develop targeted interventions designed to increase breakfast consumption.

The Differences in Alcohol Use between Urban and Rural Students of Inner Mongolia Medical University, China

Objective: The purpose of this study was to evaluate the difference in alcohol use between urban and rural students of Inner Mongolia Medical University. Methods: A cross-sectional census was conducted on medical students on campus in 2013. We use multivariate logistic regression models to assess the factors associated with alcohol use. We further use chi-square test assess on differences in alcohol use between urban and rural people among significance factors in logistic regression models. Results: The prevalence of alcohol use among students in rural area was higher than that in urban area (p = 0.016). Alcohol use was associated with Gender, monthly expenses, residence, ethnic and faculty. The odds of alcohol use for Mongolia students were 1.139 times higher than that for Han students. The prevalence of alcohol consumption among students from pharmacy or Traditional Chinese Medicine and Mongolian Medicine faculties in rural area was higher than that among student in urban area (p = 0.03;p = 0.001). The prevalence of alcohol use among female students in rural area was higher than that among female students in urban area (p < 0.043). The proportion of alcohol use among students with <600 in rural area was higher than that among students in urban area (p < 0.001). Conclusion: Considering the differences in the prevalence of alcohol use between rural area and urban area, university administrators aiming at students from various regions develop various approaches.

Comparative Study on the Development of Urban Basic Medical Insurance in 14 Cities of Liaoning Province

Objective To put forward some suggestions for the development of urban basic medical insurance of Liaoning by comparing the development situations in 14 cities of Liaoning Province.Methods Relevant data of urban basic medical insurance from 2008 to 2018 in 14 cities were collected to make a comparative analysis,and the 5 why analysis chart was drawn to investigate the development differences in 14 cities.Results and Conclusion The average growth rate of the number of urban residents covered by urban basic medical insurance varied greatly from 2014 to 2018.The range of average growth rate of urban residents’medical insurance is 19.1%,and the range of average growth rate of urban workers’medical insurance is 9.1%.Funding standards are basically the same.It is suggested each municipal government should attach importance to this issue.They can make full use of information technology to coordinate with various authorities and ensure the smooth development of medical insurance.Besides,they must actively adapt to their conditions to better develop the urban basic medical insurance of Liaoning.

共同富裕背景下基本医疗保险的受益公平性研究——基于CHARLS数据的实证分析

基于“中国健康与养老追踪调查”(CHARLS)2011—2018年四期数据,研究两类基本医疗保险参保者的城乡身份、所在地区与收入水平对基本医疗保险受益的影响及其公平性,发现城镇职工医疗保险的覆盖率较低,而城乡居民医疗保险的实际覆盖率超过政策覆盖率;城镇和东部地区、高收入参保者的受益水平较高;医疗自付费用对低收入人群形成较大负担;随着时间的推移,参保者在不同维度的受益水平和公平性有所改善。模型分析结果还表明,在城镇职工医保内部,地区差距显著,东部、中部、西部、东北地区的住院费用水平依次递减,西部地区参保人员的健康水平显著低于东部地区;在城乡居民医保内部,城镇居民的受益水平显著高于农村居民和进城农民,东部地区居民的健康水平最高,而西部地区最低;参保者收入越低则住院费用越少,健康水平也越差。上述发现与结论对于进一步缩小不同城乡、地区和收入身份特征的参保者的受益差距,促进社会公平公正,推动共同富裕,具有一定的政策启示。

农村医疗保险的减贫效应研究——基于CFPS 2018的实证分析

基于中国家庭追踪调查2018年(CFPS 2018)的数据,以相对贫困线作为贫困标准,采用二元Logistic模型实证评估农村医疗保险制度的减贫效应及其异质性。整体样本回归结果表明,农村医疗保险减贫效应显著,在相对贫困线标准下降低了43.0%的贫困发生率。异质性分析结果表明,农村医疗保险减贫效应在年龄、性别方面存在差异:在年龄方面,农村医疗保险对于中老年人的减贫效应更为显著;在性别方面,农村医疗保险对于女性的减贫效应总体高于男性。为了充分发挥农村居民医疗保险减贫的制度效能,建议:优化医疗保险内部制度设计,强化经济绩效;下沉优质医疗卫生资源,提高健康绩效;建立长效机制,提高医疗保险减贫效应精准性。

城乡居民医保整合与农村相对贫困治理的准自然实验研究

推进基本公共服务均等化、防范农村相对贫困是巩固拓展脱贫攻坚成果、促进城乡共同富裕的内在要求。论文基于2013年和2018年中国健康与养老追踪调查数据以及2013年和2019年中国家庭金融调查数据,运用双重差分倾向得分匹配模型,实证检验城乡居民医保整合对农村相对贫困脆弱性的影响。研究发现,城乡居民医保整合显著降低了农村相对贫困脆弱性。这种影响在低收入群体和受大病冲击群体中更加显著,但慢性病患者受到的影响并不显著,且城乡居民医保整合的减贫防贫效应随着脆弱性标准提高呈现下降趋势。机制检验表明,医疗费用支出、健康、劳动参与和家庭资产积累是重要的作用渠道。在此基础上,论文从动态认定相对贫困人口、促进低收入家庭应保尽保、提高农村医保实际保障水平和开展减贫绩效评估等方面提出推进农村相对贫困长效治理的政策建议。

农业保险、城镇化与共同富裕——基于城乡收入差距视角

缩小城乡收入差距是我国实现共同富裕的重要任务,农业保险作为脱贫攻坚的重要金融工具,应在全面推进乡村振兴的过程中发挥作用,进而促进共同富裕。基于2010—2021年我国30个省、自治区、直辖市(不包含港澳台地区、西藏自治区)的面板数据,结合中介效应模型,从理论和实证两方面系统诠释农业保险助推城镇化,缩小城乡收入差距的作用机制。研究结果表明:农业保险具有技术进步效应,可增加农民收入,促进劳动力城镇化转移;农业保险具有增收效应,可进一步缩小城乡收入差距;城镇化是农业保险促进共同富裕的有效中介;农业保险对共同富裕的影响存在区域异质性和城镇化水平异质性,中东部地区与低城镇化水平地区正向效用更显著。

城乡居民基本养老保险的制度优化研究

目前,我国城乡居民养老保险制度进入“从有到好”的新阶段,制度的优化成为关键问题。城乡居民养老保险制度作为“保基本”的社会保险制度,当前面临的主要问题表现在:城乡居民养老保险的待遇水平低、农村老龄人口基数大、管理层级低,公平性和可持续性发展问题凸显。为此,从保险待遇、保险结构和经办服务三个方面提出六条优化措施:提高城乡居民参保的最低缴费档次标准;设立城乡居民基本养老保险待遇的增长机制;引入集体补助促进保险缴费结构优化;引导灵活就业人员、失地农民等劳动年龄段城乡居民参加企业职工基本养老保险;探索城乡居民基本养老保险参保者转为企业职工基本养老保险参保者的分流途径和方法;探索提高城乡居民养老保险的管理层级。

健康公平视角下的城乡居民医疗支出不平等研究——基于生命周期模型

促进健康公平是中国医疗体制改革的重要目标之一。建立居民医疗支出内生决策的生命周期模型,根据实际数据采用模拟矩估计法估计城乡居民偏好参数,通过模型求解揭示居民的医疗支出行为特征及城乡差异,并讨论相关政策对城乡医疗支出不平等的影响。研究表明:城乡居民的生命周期最优医疗支出均呈现倒U型,但医疗支出水平具有明显差异;收入差距、主观偏好差异和基本医疗保险制度差异是造成该现象的重要原因且重要性依次降低;增加农村居民收入、提高农村居民医疗保险保障水平、提升医疗技术以及引入普惠型健康保险可以有效缩小城乡居民医疗支出差距。因此,应增强城乡居民医疗保险制度的福利性,积极在农村地区推广惠民保等普惠型健康保险,进一步增加农村居民收入,以缩小城乡医疗支出差距。

城乡医保统筹对缩小城乡居民收入差距的有效性研究

缩小城乡居民收入差距是实现共同富裕的基础,基于我国城乡医保制度改革的视角,使用中国劳动力动态调查(CLDS)数据构造多期双重差分模型,评估医保统筹制度对城乡居民收入差距影响的政策效果。研究结果表明:医保统筹政策相对于“新农合”与“城居保”制度显著缩小了城乡居民的收入差距,政策针对农村的低学历、中低收入以及中老年群体产生更明显的效果。机制分析进一步证明统筹医保制度可以通过降低农村居民医疗支出负担、提升其健康水平等渠道缩小城乡居民收入差距。因此,推进医疗保险统筹改革,在制度设计上应该更有针对性地向农村居民群体倾斜,提升受益公平性,为迈向共同富裕提供制度性保障。

基于政策工具、政策目标和政策力度三维分析框架的我国大病保险政策文本分析

目的探讨我国大病保险政策内部结构的均衡性及各维度间的匹配性,为我国大病保障制度的编制与优化提供理论依据。方法基于政策工具、政策目标、政策力度三维分析框架,采用内容分析法和政策文献量化分析法,对我国2012—2022年颁布的大病保险相关政策文件文本进行多维分类和交叉分析。结果政策工具维度中,政策工具运用失衡,内部结构差异较大;政策目标维度中,政策目标有所侧重,但规范监管考核仍需进一步强化,且整体协同性不足;政策力度维度中,政策力度围绕着总体平均效力上下波动幅度不大,呈现波浪式前进的趋势。结论目前,我国大病保险政策在组织建设和人才培养方面的使用频率明显过低,规范监管考核的政策目标占比也较低,且多部门共治支撑各政策目标有效实现的格局尚未普遍形成,政策整体协同性有待进一步提高。建议统筹协调大病保险政策工具的运用,调整内部结构并完善政策目标的结构,加强监管考核的规范力度,以提高政策体系的协调性,优化实施效果。

基于Fairlie分解的流动人口灾难性医疗支出的城乡差异及影响因素分析

目的:分析流动人口灾难性医疗支出的城乡差异及影响因素,为促进城乡流动人口健康公平提供建议参考。方法:基于2018年全国流动人口动态监测调查,运用卡方检验探究城乡流动人口特征分布差异,利用基于logistic回归的Fairlie分解法分析流动人口灾难性医疗支出的城乡差异及影响因素。结果:流动人口灾难性医疗支出发生率为24.25%,其中城镇发生率显著低于农村(P<0.05);Fairlie分解显示流动人口灾难性医疗支出的城乡差异中特征效应占95.53%,系数效应占4.47%,收入水平、健康状况、婚姻情况、医保报销情况及是否接受健康教育对该差异产生作用(P<0.05)。结论:农村流动人口的灾难性医疗支出风险高于城镇,收入水平和健康状况差异起主要作用。应加强农村流动人口的健康教育与劳动保障,提高城乡健康公平性,通过改进医保报销机制缩小流动人口灾难性医疗支出的城乡差异。

城乡基本医疗保险制度实施对家庭消费的影响效应及作用机制

基于1988—2018年中国家庭收入调查数据,以城乡基本医疗保险制度实施为准自然实验,采用双重差分法考察了城镇基本医疗保险与新型农村合作医疗保险(即新农合)对家庭消费率的影响及其机制。结果显示:相较于未参保家庭,参加城镇医保的家庭消费率显著高出1.01%,但新农合的影响不显著;机制分析发现,城镇医保促进了参保家庭的总消费和分项消费支出,但新农合对消费支出无显著影响,同时,城镇医保和新农合对总收入和大部分分项收入无显著影响,这与基准回归结果一致;异质性分析表明,城镇医保更多地提升了中老年、非富裕、不健康群体,以及西部地区的家庭消费率。对此,应当充分发挥基本医疗保险制度对提振家庭消费率的积极作用,对“大水漫灌”式的财政补助应进行反思;改变基本医保“户保分离”“业保分离”的现状;加强针对特定人群的医保政策;注重提高参保青年和健康群体的获得感。

城乡医保统筹影响流动老人医疗服务利用、医疗负担及健康损耗的机制分析和实证检验

利用中国健康与养老追踪调查(CHARLS)2013—2020年四期数据,采用固定效应模型实证城乡医保统筹对流动老人医疗服务利用、医疗负担及健康损耗的影响效应。研究结果表明:与新农合相比,城乡医保统筹提高了流动老人的就诊次数,降低了流动老人的医疗负担,并对流动老人的认知损耗有显著抑制作用,但未对其住院次数和行动损耗产生显著影响。通过工具变量法回归后,城乡医保统筹一定程度上降低了流动老人的行动损耗。进一步分析发现:城乡医保统筹对女性流动老人、有家庭照料的流动老人、健康状况较差的流动老人就诊次数和认知损耗的影响更大,也显著减少了无家庭照料流动老人的住院次数。基于此,提出相应对策建议。

基于城乡居民基本养老保险基础养老金建立国民基础养老金:实施路径和可行性分析

本文探讨基于城乡居民基本养老保险基础养老金建立国民基础养老金的实施路径和可行性。2022年年末我国至少还有1235万人口尚未参加基本养老保险。基于城乡居保基础养老金建立完全由财政筹资的普惠式非缴费型养老金,即国民基础养老金,可以为这些人提供老年基本生活保障,防止老年贫困。如果让目前尚未参加基本养老保险的老年人无须缴费即可直接享受城乡居保基础养老金待遇,同时加快将城乡居保基础养老金提高到农村低保水平,即可逐步实现基本养老保障“人口全覆盖”。在此基础上从城镇职工基本养老保险财政补贴中按农村低保水平划出相应部分,即可建立全民统一的国民基础养老金,为多层次养老保障体系建设奠定坚实基础。本文按照2030年城乡居保基础养老金达到全国农村低保水平的目标,测算了建立国民基础养老金所需新增财政资金,研究认为通过调整基本养老保险财政补贴支出结构可以实现上述目标。

城乡居民养老保险对家庭双代经济流动的影响——基于中国健康与养老追踪调查数据

利用“中国健康与养老追踪调查”(CHARLS)数据,通过构建多元线性模型,实证分析城乡居民养老保险对家庭内部亲子代经济流动的影响。结果发现,“经济面向”的城乡居民养老保险挤出了子代向亲代提供的经济支持,但对亲代的经济“逆反哺”并无显著影响;双代婚姻状况、受教育水平和亲代家庭资产均正向显著影响家庭代际经济的双向流动;子女之间存在“攀比效应”和“示范效应”;子代家庭收入正向影响向上代际经济支持。因此,老年人养老水平的提高需要从国家、社会和家庭层面共同着力:国家提高城乡居民养老保险的保障水平,鼓励老年人隔代照料孙子女;市场进一步完善养老服务;家庭发挥情感保障作用,关照独子女失能老人。

中国城乡居民养老保险的收入差距调节效应

城乡居民基本养老保险作为社会养老保险体系的核心组成部分,理应在更好解决“老有所养”的同时,发挥出进一步破解城乡二元格局、调节收入分配和缩小城乡差距的功能与效果。基于相关年份分省面板数据和中国家庭追踪调查(CFPS)数据,对现阶段城乡居民基本养老保险收入差距调节效应,结合宏观和微观两个视角逐步进行了实证检验与分析探讨。研究结果表明,在全国层面上,现阶段城乡居民基本养老保险发展与城乡收入差距之间存在显著非线性关系,并且呈现出先扩大而后缩小的“倒U形”轨迹;同时,微观检验也部分地验证了这一结果。为此提出:(1)应高度重视城乡居民基本养老保险的收入分配调节功能与差异化发展趋势;(2)应逐步完善城乡居民基本养老保险的缴费和待遇调整机制;(3)应通过高质量发展和促进农民和弱势群体收入增长来更好地发挥城乡居民基本养老保险的消除老年贫困和收入分配调节功能。

农村地区城乡居民基本医疗保险制度反贫困效果研究——基于中国家庭追踪调查数据的实证分析

党的二十届三中全会指出,要切实保障和改善民生,巩固拓展脱贫攻坚成果。农村地区城乡居民基本医疗保险制度是医疗保障反贫困政策体系的重要组成部分。基于2012年、2014年、2016年、2018年中国家庭追踪调查(CFPS)数据,采用固定效应模型和倾向得分匹配-双重差分法,从收入贫困和能力贫困多维度探讨农村地区城乡居民基本医疗保险制度的反贫困效果。实证研究发现,农村地区城乡居民基本医疗保险制度的反贫困效果显著,但反贫困效果呈下降趋势;大病保险进一步增强了反贫困效果,且反贫困效果呈上升趋势。因此,应提高农村地区城乡居民基本医疗保险制度的可持续性,强化农村三重医疗保障制度反贫困的综合保障能力,并进一步提高大病保险的保障力度。