医疗保险政策对老年流动人口健康的影响——来自中国的证据。
The Impact of Health Insurance Policy on the Health of the Senior Floating Population-Evidence from China.
机构信息
Centre for Social Security Studies, Wuhan University, Wuhan 430072, China.
School of Public Management, South-Central University for Nationalities, Wuhan 430074, China.
出版信息
Int J Environ Res Public Health. 2018 Oct 1;15(10):2159. doi: 10.3390/ijerph15102159.
The impact of health insurance on residents' health is one of the focal points of academic research. Due to the fact that China's medical insurance system is composed of a variety of programs and that the pooling districts are at the lower administrative level, enrollment in different medical insurance programs or at different places may have certain influences on the health of residents. This has mostly been neglected by previous studies. This paper uses data from the 2015 China Migrants Dynamic Survey (CMDS), focusing on the senior floating population and taking the difference in government subsidy proportions as an instrumental variable in order to identify the effects of health insurance programs and regional differences on the health of the senior floating population. Three effects were observed: First, participation in the health insurance system significantly improves floating seniors' self-rated health. Second, the health status of floating seniors affects their choice of health insurance program: Less healthy persons tend to choose high-paying, wide-coverage basic medical insurance available for urban employees. Using an instrumental variable to control for the problem of endogeneity, it is discovered that compared with the basic medical insurance system for urban residents, the system for urban employees significantly enhances the health of the senior floating population. Third, "adverse selection" could be observed in the choice between enrolling in health insurance at the place of settlement or another place. Senior migrants with worse self-rated health tend to choose place of settlement in order to enjoy higher compensation and less complex reimbursement procedures. With an instrumental variable to control for the problem of endogeneity, it was found that compared with joining the medical insurance system at other places, joining at a place of settlement could improve the health of the floating senior population.
医疗保险对居民健康的影响是学术研究的焦点之一。由于中国的医疗保险制度由多种计划组成，并且统筹地区处于较低的行政级别，因此参加不同的医疗保险计划或在不同的地方参保可能会对居民的健康产生一定的影响。这在以前的研究中大多被忽视了。本文利用 2015 年中国流动人口动态监测调查（CMDS）的数据，聚焦于老年流动人口，以政府补贴比例的差异作为工具变量，以识别医疗保险计划和地区差异对老年流动人口健康的影响。观察到了三种效应：第一，参加医疗保险制度显著提高了流动人口老年人的自评健康。第二，流动人口老年人的健康状况影响他们对医疗保险计划的选择：健康状况较差的人倾向于选择为城镇职工提供的高缴费、广覆盖的基本医疗保险。使用工具变量控制内生性问题后发现，与城镇居民基本医疗保险制度相比，城镇职工基本医疗保险制度显著提高了老年流动人口的健康水平。第三，在选择在定居地或其他地方参加医疗保险方面可能会出现“逆向选择”。自评健康状况较差的老年移民更倾向于选择在定居地参保，以享受更高的补偿和更简单的报销手续。使用工具变量控制内生性问题后发现，与在其他地方参加医疗保险相比，在定居地参加医疗保险可以改善流动人口老年人的健康状况。
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