医疗保险对我国农民工医疗与健康状况的影响
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| Title | The Effect of Health Insurance Participation on the Health and Healthcare Utilization of Migrant Workers in China
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| 作者 | 秦雪征 刘国恩 王歆 |
| Author | Qin Xuezheng, Liu Gordon G. and Wang Xin |
| 作者单位 | 北京大学经济学院，北京大学光华管理学院、北京大学中国卫生经济研究中心，美国科罗拉多大学经济学系 |
| Organization | School of Economics, Peking University; Guanghua School of Management, Peking University; |
| 作者Email | qin.econpku@gmail.com，gordon@gsm.pku.edu.cn，wangxin.pkuecon@gmail.com |
| 中文关键词 | 城镇职工基本医疗保险 城镇居民基本医疗保险 新型农村合作医疗保险 农民工 |
| Key Words | Urban Employee Basic Medical Insurance (UEBMI); Urban Resident Basic Medical Insurance (URBMI); New Rural Cooperative Medical Scheme (NRCMS); Migrant Workers |
| 内容提要 | 流动于城镇与农村之间的农民工群体一直是我国医疗保障覆盖的薄弱环节，他们的医疗与健康状况受到社会的日益关注。本文利用2007-2010年国务院城居保试点评估入户调查数据，着重考察目前主要医疗保险政策在解决农民工“看病难、看病贵”问题上的实施效果。我们采用卫生经济学领域标准的3A（accessibility, affordability & appropriateness）评估框架，尝试回答以下三方面问题：目前各主要医疗保险项目是否有助于减轻农民工的看病负担？是否有助于促进农民工对正规卫生服务资源的使用？是否有助于提高农民工群体的身体健康水平？结果显示，在控制参保行为的内生性后，城镇职工基本医疗保险和公费医疗在降低农民工门诊和住院费用自付比例、增加体检次数及改善健康状况等方面发挥了突出作用，而新型农村合作医疗、城镇居民基本医疗保险和商业健康保险则显著提高了农民工的健康意识和对预防性医疗服务的利用率。然而，由于门诊统筹机制的缺失和制度衔接的不完善，多数保险在减轻农民工实际就医负担以及引导其患病后合理就医等方面没有发挥应有的效果。我们由此对进一步深化医疗保障体制改革提出了政策建议。 |
| Abstract | Rural-to-urban migrant workers are an under-represented group in the health insurance system in China, and the status of their health and healthcare utilization has been paid increasing attention by the society. This paper uses the 2007-2010 State Council URBMI Household Survey data to evaluate the efficacy of major health insurance platforms on solving the “difficult and expensive care” problem among the migrant workers. We apply the 3A (Accessibility, Affordability & Appropriateness) framework to answer 3 main questions: does participating in the health insurance programs help to alleviate migrant workers’ financial burden of healthcare? Does it provide better access to formal healthcare? Does it ultimately improve their health status? After controlling for the endogeneity of insurance participation, our results indicate that the Urban Employee Basic Medical Insurance (UEBMI) and the Government Employee Medical Insurance (GEMI) are effective in lowering the inpatient and outpatient cost burden, increasing the number of physical exams, and improving the self-rated-health for the migrant workers, while the New Rural Cooperative Medical Scheme (NRCMS), the Urban Resident Basic Medical Insurance (URBMI) and the commercial health insurance shows significant benefit in boosting the health awareness and preventive care utilization. However, due to the lack of systematic financing scheme for outpatient care and the segmentation between insurance programs, the current policies have not effectively addressed the problem of high out-of-pocket cost and under-utilization among the migrant workers. |
| 文章编号 | WP221 |
| 登载时间 | 2012-02-15 |
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