Xu Wei, Cai Gong-Jie, Li Guan-Nan, Cao Jing-Jing, Shi Qiong-Hua, Bai Jie
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
Institute of Chinese Medical Science, University of Macau, Macau, China.
J Glob Health. 2016 Dec;6(2):020801. doi: 10.7189/jogh.06.020801.
The New Cooperative Medical Scheme (NCMS) for peasantries implemented in 2003 and the Urban Resident Basic Medical Insurance (URBMI) for the urban unemployed implemented in 2007 have many similarities. They both apply the financing mode of individual premiums plus government's subsidies, and the voluntary enrollment. The Chinese government plans to integrate these two systems and build a unified basic medical insurance system for the unemployed in order to achieve the medical equity and increase the general health level. Thus, to analyze the main influencing factors of the enrollment of the urban unemployed and rural residents is very important for improving the system and securing the stability of the system during the transition.
The study uses data from the China Health and Nutrition Survey (CHNS) and adopts logistic regression models to test which factors influence the enrollment of the URBMI and the NCMS under the background of rather high enrollment rate of Chinese basic medical insurances and strong fiscal support of the Chinese government, especially whether health status or age influences enrollment of these two insurances greater.
There is indeed some adverse selection in the URBMI and the NCMS. Whether the individual has chronic diseases have significant influence on enrollments of both the urban unemployed and rural residents, while whether the individual got ill in last four weeks just influences enrollments of the urban unemployed. Age influences enrollment greater than health status. The older the insured are, the larger the enrollment rates are.
Because of the active support for basic medical insurances of the Chinese government, the enrollment performance of the urban unemployed and rural residents has already changed. When implementing the new policy, the government should pay attention to the willingness to enroll in and the change of enrollment performance of the insured. Therefore, under the policy of voluntary enrollment, every coordinated province and city should enlarge the proportion of young people to insuring group, optimizing the age structure, and the financing proportion of governments and individuals should be measured properly. With the increasing of governments' subsidies, the proportion of individual's premiums should also be increased.
2003年实施的新型农村合作医疗制度（新农合）和2007年实施的城镇非就业居民基本医疗保险（城居医保）有诸多相似之处。二者均采用个人缴费加政府补贴的筹资模式，且参保自愿。中国政府计划整合这两个制度，建立统一的非就业居民基本医疗保险制度，以实现医疗公平并提高整体健康水平。因此，分析城镇非就业居民和农村居民参保的主要影响因素，对于完善该制度以及在转型期确保制度稳定至关重要。
本研究使用中国健康与营养调查（CHNS）的数据，并采用逻辑回归模型，在我国基本医疗保险参保率较高且政府财政支持力度较大的背景下，检验哪些因素影响城居医保和新农合的参保情况，特别是健康状况或年龄对这两种保险参保的影响是否更大。
城居医保和新农合确实存在一定程度的逆向选择。个人是否患有慢性病对城镇非就业居民和农村居民的参保均有显著影响，而个人在过去四周内是否生病仅影响城镇非就业居民的参保。年龄对参保的影响大于健康状况。参保者年龄越大，参保率越高。
由于中国政府对基本医疗保险的积极支持，城镇非就业居民和农村居民的参保情况已发生变化。在实施新政策时，政府应关注参保意愿以及参保者参保情况的变化。因此，在参保自愿的政策下，各统筹省市应扩大年轻人在参保群体中的比例，优化年龄结构，并合理确定政府与个人的筹资比例。随着政府补贴的增加，个人缴费比例也应相应提高。
